Causes Analysis And Management Strategies For Postoperative Haemorrhage Of Blunt Hepatic Trauma

Objective To analyse the causes and the management Strategies for postoperative haemorrhage of blunt liver trauma.Methods Clinical data of 63 patients with postoperative of blunt liver trauma were reviewed retrospectively in the Fuzhou General Hospital of Nanjing Military Command between September 1,2003 and September 30,2016.Especially in situation of peritoneal drainage tube.According to the severity of liver injury and whether postoperative drainage tube discharged pus,we respectively divided into mild and severe liver injury group,drainage of pus and no drainage group to compare difference in bleeding rates.In the light of whether postoperative of liver trauma was hemorrhage,we separated into bleeding and no bleeding group to compare difference in preoperative prothrombintime(PT).Results 23 cases(36.50%)of 63 cases with postoperative of blunt liver trauma appeared various degrees haemorrhage,including post-hepatectomy 20 cases,of which 4 cases were grade A,7 cases grade B,and 9 cases grade C by the standard of post-hepatectomy haemorrhage(PHH)of the International Study Group of Liver Surgery(ISGLS).The median time of postoperative haemorrhage was 24 hours,and from diagnosis of postoperative bleeding to reoperation or intervention was 3 hours.Twelve cases were successfully treated by nonoperative treatment,and eleven cases by second operation,of which nine cases were PHH,with peritoneal drainage occurred numerous bright or dark red blood in postoperative 48 h.Three patients died of postoperative hemorrhage,including two patients of second surgery and the mortality rate was 13.04%(3/23),and reoperation mortality 18.2%(2/11).Bleeding rate of severe liver injury and postoperative drainage of pus were significantly higher than mild liver injury and not drainage of pus(P = 0.047 and P=0.01).The extension time of PT of liver injury postoperative bleeding significantly longer than not bleeding patients(P = 0.000).Conclusion Bleeding was a serious complication after liver trauma postoperative,and the mortality was higher,mainly for PHH.Liver trauma postoperative hemorrhage primarily related to vascular occult bleeding,the severity of liver trauma,coagulation dysfunction,and wound infection.Early bleeding of postoperative of liver trauma preferred nonoperative treatment,and vital signs instability or persistent declining of hemoglobin required second surgery.Taking corresponding treatment measures according to different bleeding causes,which can minimize postoperative bleeding mortality.