The Experimental Study Of Balloon Tamponade Applying In The Hemostasis Treatment Of Blunt Liver Trauma

As the introduction of damage control surgery and the accumulation of clinical experience during the last century, the management of blunt liver trauma has changed dramatically. In the early 1900s, there was a shift from observation and expectant management toward operative management emphasizing non-resection techniques. By the 1980s, patients were being managed with packing, and in the 1990s, there was another shift to a selective non-operative approach. Since then, non-operative management with selective operative intervention has remained the standard of care. Only patients who are haemodynamically unstable or have diffuse peritonitis after blunt abdominal trauma should undergo laparotomy urgently. However, blunt liver trauma with concomitant injuries of other abdominal viscus organs is still controversial.In the circumstance of blunt liver trauma with concomitant injuries of other abdominal viscus organs, bleeding after liver trauma is also an important factor thretening the trauma patient’s life. Under this circumstance, bleeding should have be aggravated due to both the rupture of injuried organs and abdominal infection after the run-off of viscus contents. While the simple abdominal packing may lead to a higher risk of bleeding. The prophase clinical retrospective study showed, patients with blunt liver trauma with concomitant injuries of other abdominal viscus organs suffered higher risks of bleeding. During the management of blunt liver trauma with concomitant injuries of other abdominal viscus organs, the fast and simple method to control bleeding, could not only accommodate the concept of damage control surgery, but also reduce the mortality and improve the prognosis of liver trauma.The goal of the present study was to establish a severe multiple organ trauma model for big animal with blunt liver trauma and concomitant injuries of small intestine. A total of 24 local swines were randomly devided into 4 groups:simple abdominal packing(Group A), abdominal packing with negative pressure drainage(Group B), abdominal packing with balloon tamponade(Group C), abdominal packing with balloon tamponade and negative pressure drainage(Group D). We aimed at comparing the difference of hemostasis with each other. On the indicators of hemostasis, such as blood loss, hemoglobin level, hematocrit and prothrombin time, Group C was better than that in Group A, Group D was better than Group B. While no significant difference was found between Group A and Group B, Group C and Group D. On the indicators of infection status, notwithstanding there was not any positive evidence in bacterial culture. But on the white blood cell count, lactate level, IL-6, IL-10, TNF-α, ET, MPO and other inflammatory cytokine in peripheral blood, Group A was significantly higher than that in Group B, Group C was significantly higher than Group D. While no significant difference was found between Group A and Group C, Group B and Group D.In conclusion, in the management of concomitant blunt liver trauma with injuries of small intestine, abdominal packing with balloon tamponade could significantly reduce bleeding without increasing the risk of infection. Abdominal packing with balloon tamponade and negative pressure drainage accommodate the concept of damage control surgery, could not only reduce incidence of infection, but also control hemorrhage effectively, which should have a better prognosis in the management of liver trauma.