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Clinical outcomes of non-operative management and clinical observation in non-angioembolised hepatic trauma: A systematic review of the literature

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Chinese Journal of Traumatology 2022年第5期25卷 257-263页

作者： Francesco Virdis Mauro Podda Salomone Di Saverio Jayant Kumar Roberto Bini Carlos Pilasi Isabella Reccia Trauma and Acute Care Surgery Unit Ospedale NiguardaMilano20162Italy General and Emergency Surgery Policlinico Universitario di MonserratoCagliari0910 Italy General and Endocrine Surgery Ospedaledi CircoloFondazione MacchiVarese21100 Italy Abdominal Transplantation Surgery University of ChicagoChicago5801USA General and Trauma Surgery San Juan de Dios HospitalSantiago8350488Chile Haepato-Biliary-Pancreatic Uni Hammersmith Hospital Imperial CllegeLondonW120TSUK

Purpose: Liver is the most frequently injured organ in abdominal trauma. Today non-operative management (NOM) is considered as the standard of care in hemodynamically stable patients, with or without the adjunct of angioembolisation (AE). This systematic review assesses the incidence of complications in patients who sustained liver injuries and were treated with simple clinical observation. Given the differences in indications of treatment and severity of liver trauma and acknowledging the limitations of this study, an analysis of the results has been done in reference to the complications in patients who were treated with AE. Methods: A systematic literature review searched "liver trauma" , "hepatic trauma" , "conservative management" , "non operative management" on MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials databases, EMBASE, and Google Scholar, to identify studies published on the conservative management of traumatic liver injuries between January 1990 and June 2020. Patients with traumatic liver injuries (blunt and penetrating) treated by NOM, described at least one outcome of interests and provided morbidity outcomes from NOM were included in this study. Studies reported the outcome of NOM without separating liver from other solid organs;studies reported NOM complications together with those post-intervention;case reports;studies including less than 5 cases;studies not written in English;and studies including patients who had NOM with AE as primary management were excluded. Efficacy of NOM and overall morbidity and mortality were assessed, the specific causes of morbidity were investigated, and the American Association for the Surgery of Trauma classification was used in all the studies analysed. Statistical significance has been calculated using the Chi-square test. Results: A total of 19 studies qualified for inclusion criteria were in this review. The NOM success rate ranged from 85% to 99%. The most commonly reported complications

关键词： Liver Trauma non-operative management Angioembolization

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Liver trauma: What current management?

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Hepatobiliary & Pancreatic Diseases International 2018年第1期17卷 39-44页

作者： Mohamed Tarchouli Mohamed Elabsi Noureddine Njoumi Mohamed Essarghini Mahjoub Echarrab Mohamed Rachid Chkoff Department of Digestive Surgery Mohammed V Military Hospital Faculty of Medicine and Pharmacy Sidi Mohamed Ben Abdellah University Department of Visceral Surgical Emergency Ibn Sina Hospital Faculty of Medicine and Pharmacy Mohammed V University Department of Digestive Surgery Mohammed V Military Hospital Faculty of Medicine and Pharmacy Mohammed V University

Background: The liver is the most commonly damaged organ in abdominal trauma. The management of liver trauma has experienced many changes over the last two decades. Currently there is a trend toward a non-operative treatment warranted by the successful pediatric experience and better results recorded in many trauma centers worldwide. This study aimed to evaluate outcomes of operative and non-operative management of liver trauma in our institution over the last five ***: The patients with a diagnosis of blunt or penetrating liver injuries, admitted and managed in our hospital from January 2012 to December 2016 were retrospectively studied. The patients were divided into 2 groups, operated and non-operated groups, according to the initial management considered appropriate at the time of patient admission. Clinical features and outcomes were ***: The study involved 83 patients, with a mean age of 33 years and a marked male predominance(85.5%). The most common type of lesions was blunt trauma and the main cause was road traffic accidents. Sixty-eight liver injuries(81.9%) were of low severity(grades Ⅰ,Ⅱ,Ⅲ), while 15(18.1%) were of high severity(grade Ⅳ or greater). Fifty-six patients(67.5%) had multiple injuries. Surgical treatment was performed in 26(31.3%) patients. non-operative management was undertaken in 57 cases(68.7%). The morbidity and mortality rates were clearly lower in non-operative patients compared to those in the operated ***: Careful non-operative management is an adequate therapeutic strategy for the patients suffering from liver trauma with stable hemodynamics. Patients with complex hepatic trauma and especially those with other organ injuries continue to have significantly higher mortality.

关键词： Liver trauma non-operative management Surgical treatment

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Current debate in the oncologic management of rectal cancer

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World Journal of Gastrointestinal Oncology 2016年第10期8卷 715-724页

作者： Trish Millard Paul R Kunk Erika Ramsdale Osama E Rahma Division of Hematology-Oncology Department of MedicineUniversity of Virginia Health System Center for Immuno-Oncology/GI Oncology Dana-Farber Cancer Institute

Despite the considerable amount of research in the field,the management of locally advanced rectal cancer remains a subject to *** date,effective treatment centers on surgical resection with the standard approach of total mesorectal *** therapy and chemotherapy have been incorporated in order to decrease local and systemic *** it is accepted that a multimodality treatment regimen is indicated,there remains significant debate for how best to accomplish this in regards to order,dosing,and choice of *** radiation is the standard of care,yet remains debated with the option for chemoradiation,short course radiation,and even ongoing studies looking at the possibility of leaving radiation out *** was traditionally incorporated in the adjuvant setting,but recent reports suggest the possibility of improved efficacy and tolerance when given *** this review,the major studies in the management of locally advanced rectal cancer will be *** addition,future directions will be considered such as the role of immunotherapy and ongoing trials looking at timing of chemotherapy,inclusion of radiation,and nonoperative management.

关键词： Chemoradiation Immunotherapy non-operative management Neoadjuvant chemotherapy Rectal cancer

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Outcome analysis of management of liver trauma: A 10-year experience at a trauma center

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World Journal of Hepatology 2016年第15期8卷 644-648页

作者： Wong Hoi She Tan To Cheung Wing Chiu Dai Simon HY Tsang Albert CY Chan Daniel KH Tong Gilberto KK Leung Chung Mau Lo Department of Surgery Queen Mary Hospital the University of Hong Kong

AIM: To review the outcomes of liver trauma in patients with hepatic injuries only and in patients with associated injuries outside the ***: Data of liver trauma patients presented to our center from January 2003 to October 2013 were reviewed. The patients were divided into two groups. Group 1 consisted of patients who had hepatic injuries only. Group 2 consisted of patients who also had associated injuries outside the ***: Seven(30.4%) patients in group 1 and 10(28.6%) patients in group 2 received non-operative management; the rest underwent operation. Blunt trauma occurred in 82.8%(48/58) of the patients and penetrative trauma in 17.2%(10/58). A higher injury severity score(ISS) was observed in group 2(median 45 vs 25, P non-operative management was possible for selected patients. Associated injuries outside the liver usually account for morbidity and mortality.

关键词： non-operative management Liver trauma Multiple injuries Penetrative trauma Liver laceration Blunt trauma

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Scapula Fracture in a Child: Report of a Rare Injury

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Open Journal of Pediatrics 2023年第2期13卷 158-163页

作者： Florent Tshibwid A. Zeng Mbaye Fall Nankouman Konaté Faty Balla Lô Eben-Ezer Samé Souleymane Camara Aimé Lakh Faye Fall Oumar Ndour Gabriel Ngom Department of Pediatric Surgery Aristide Le Dantec University Teaching Hospital Cheikh Anta Diop University Dakar Senegal Department of Pediatric Surgery Albert Royer National Children’s Hospital Center Cheikh Anta Diop University Dakar Sene-gal

Scapular fracture is exceptional in children, mainly occurring after high-energy trauma. Radiologic investigations help its diagnosis and classification, which determines its management. We report the case of a 14-year-old patient admitted for blunt trauma of the left shoulder after falling from a speeding car. The diagnosis of a displaced fracture of the body of the scapula was made, and non-operative treatment was indicated and carried out for four weeks, followed by physiotherapy for another four weeks. Nine weeks after the trauma, the mobility of the affected shoulder was equivalent to that of the contralateral shoulder.

关键词： Fracture Scapula Child non-operative management Case Report

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