tailieunhanh - Báo cáo hóa học: " Non operative management of liver and spleen traumatic injuries: a giant with clay feet"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành hóa học dành cho các bạn yêu hóa học tham khảo đề tài: Non operative management of liver and spleen traumatic injuries: a giant with clay feet | Di Saverio et al. World Journal of Emergency Surgery 2012 7 3 http content 7 1 3 WJES WORLD JOURNAL OF EMERGENCY SURGERY COMMENTARY Open Access Non operative management of liver and spleen traumatic injuries a giant with clay feet 1 2 f -I- 1-1 5 3 6 Salomone Di Saverio Ernest E Moore Gregorio Tugnoli Noel Naidoo Luca Ansaloni Stefano Bonilauri Michele Cucchi4 and Fausto Catena4 After years of initial aggressive surgical intervention and a subsequent shift to damage control surgery DCS non operative management NOM has been shown to be safe and effective. In fact trauma surgeons realized that in liver trauma it was safer to pack livers 1 than do finger fracture 2 or resection and this represented a tangential issue to nonoperative approach. Damage control was not the paradigm shift for spleen and liver but rather to address coagulopathy that was more commonly associated with penetrating major abdominal vascular injuries 3 . The shift to nonoperative care was largely motivated by intraoperative observations that many minor liver 4 and splenic injuries 5 were found no longer bleeding. Then CT arrived in the early 1980s and confirmed that many moderate liver and spleen injuries did not require OR intervention. Pediatric surgeons first lead the shift to nonoperative management for splenic trauma 6 7 . In the 90 s it became the gold standard for liver injuries in hemodynamically stable patients regardless of injury grade and degree of hemoperitoneum 8 allowing better outcomes with fewer complications and lesser transfusions 9 . Nevertheless concerns have been raised regarding continuous monitoring required 10 safety in higher grades of injury 11 and general applicability of NOM to all haemodynamically stable patients 12 . Similarly in the same period and following promising results obtained with splenic salvage 13 with several surgical techniques 14 such as splenorraphy high intensity ultrasound haemostatic wraps and staplers 15 NOM became the treatment of .