ผลการรักษาผู้ป่วยเด็กที่ได้รับบาดเจ็บที่ตับ ในโรงพยาบาลนครปฐม

บทคัดย่อ

Purpose: In 2002, the American Pediatric Surgical Association (APSA) recommended evidencebased guidelines for the management of hemodynamically stable patients with isolated liver injuries. Nonoperative treatment in hemodynamic stable patient became standard treatment in liver injury. Aim of this study is to review treatments of liver injuries in pediatric patients in Nakhonpathom hospital.

Methods: Pediatric patients with liver injury between October 2006 to September 2011 were reviewed. Groups were analyzed for gender, age, causes of injury, liver injury grade, associated injury, injury severity score (ISS), treatment method, length of hospital stay, mortality rate, blood transfusion volume and complication after treatment.

Results: During the study period, 15 patients with liver injury were treated. Mean age was 7.6 ± 3.9 years and 60% were male. Low grade liver injury (grade1-3) patients were 53.3% with no mortality. Overall mortality rate was 33.33%, whereas in liver injury grade 5 mortality rate was 80%. Associated injury was found in 60% of patients and most common associated injury was hemo-pneumothorax with high mortality rate at 100% when found both conditions. ISS increased simultaneously with grade of liver injury and significantly lower in non-operative than operative treatment.

Conclusions: Despite non-operative treatment became a standard and safety treatment in hemodynamic stable pediatric liver injury, close follow up in these patients is still necessary. The mortality rate of hemodynamic instability patients are still high when they have associated injuries.