非手术治疗闭合性肝损伤远期疗效的分析

Long-Term Outcomes of Non-operative Management for Blunt Liver Injuries

目的评估闭合性肝损伤患者接受非手术治疗成功后的远期疗效。方法选取2013年1月1日至2017年12月31日收治的185例闭合性肝损伤患者,经非手术治疗成功后,利用调查问卷对远期并发症进行评估。分别以出院后是否经历慢性腹痛、再发感染、排便异常分组,比较各组间性别、年龄、随访时间、肝脏损伤分级、创伤严重程度评分差异是否有统计学意义。结果最终纳入研究的128例患者中92例(71.9%)患者完成有效问卷,平均随访时间35.5(16.75)个月。35例(38.0%)患者在出院后出现至少一种以下症状:慢性腹痛18例(19.6%),再发感染10例(10.9%),排便异常11例(12.0%)。发生远期并发症的患者年龄[(38.1±11.4)岁]低于无并发症的患者[(45.7±13.4)岁],差异有统计学意义(t=2.799,P=0.006)。以上述三种并发症分组,各组间性别、年龄、肝损伤分级、创伤严重程度评分差异无统计学意义。慢性腹痛的患者随访时间[30.5(11.25)个月]短于无慢性腹痛的患者[36(27.5)个月],差异有统计学意义(U=401.0,P=0.009)。出现再发感染的患者中合并脾损伤5例(50.0%)高于无再发感染的患者9例(11.0%),差异有统计学意义(χ~2=7.714,P=0.005)。报告排便异常的患者中合并骨盆损伤6例(54.5%)高于无排便异常的患者9例(11.1%),差异有统计学意义(χ~2=10.395,P=0.001)。结论经非手术治疗成功的闭合性肝损伤患者中,慢性腹痛的发生和持续可能随伤后时间的推移逐渐减少;合并脾损伤和骨盆损伤的患者分别更容易出现再发感染和排便异常。

Objective The aim of this study was to assess long-term effect among patients undergoing successful non-operative management （sNOM） for blunt liver injuries. Methods Long-term symptoms were evaluated through a designed questionnaire on 185 patients undergoing sNOM for blunt liver injuries. Patients were respectively allocated into different groups according to experience of chronic abdominal pain, recurrent infections and irregular bowel movements. Gender, age, follow-up time, grade of liver injuries and injury severity score were compared among those groups by statistics. Results Among 128 patients finally enrolled in this study, 92 （71.9%） patients responded to the questionnaire. Median （IQR） follow-up time was 35.5 （16.75） months. 35 （38.0%） patients reported at least one of the following symptoms： 18 （19.6%） chronic abdominal pain, 10 （10.9%） recurrent infections and 11 （12.0%） irregular bowel movements. Patients with long-term symptoms were significantly younger（38.1±11.4 years） than asymptomatic patients（45.7±13.4 years）（t=2.799,P=0.006）.No significant difference between subgroups with/without the above-mentioned symptoms in the aspect of gender, age, grade of liver injuries or injury severity score was found. Compared to asymptomatic patients [36（27.5） months], those suffering from chronic abdominal pain [30.5（11.25） months] had undergone a shorter follow-up period （U=401.0, P=0.009） . Higher incidence of splenic injuries was observed among patients with recurrent infections [5（50.0%）] compared with those without recurrent infections [9（11.0%）]（χ^2=7.714,P=0.005）. Pelvic injuries were significantly more frequent in patients with irregular bowel movements [6（54.5%）] than those without irregular bowel movements [9（11.1%）]（χ^2=10.395, P=0.001）. Conclusion Among patients with blunt liver injuries undergoing sNOM, incidence and persistence of chronic abdominal pain may decrease even years after trauma. Patients with splenic and pelvic injuries tend to have more morbidity of recurrent infections and irregular bowel movements, respectively.