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文献考察：１）鈍的肝損傷の85％は保存的治療が可能
Arch Surg. 2003 May;138(5):475-80; discussion 480-1.
High success with nonoperative management of blunt hepatic trauma: the liver is a sturdy organ.
Velmahos GC, Toutouzas K, Radin R, Chan L, Rhee P, Tillou A, Demetriades D.
HYPOTHESIS: Nonoperative management of liver injuries (NOMLI) is highly successful and rarely leads to adverse events. DESIGN: Prospective observational study. SETTING: High-volume academic level I trauma center. PATIENTS: For 26 months, 78 consecutive unselected patients with liver injuries were followed up prospectively. In the absence of hemodynamic instability or signs of hollow visceral trauma, NOMLI was offered irrespective of the magnitude of the liver injury.Main Outcome Measure Failure of NOMLI, defined as a laparotomy after an initial decision to treat the patient nonoperatively. RESULTS: Of the 78 patients, 23 (29%) were operated on immediately, but only 12 (15%) for bleeding from the liver. All 12 patients required packing in addition to other maneuvers (hepatorrhaphy [n = 8], resection [n = 4], and liver isolation [n = 1]). Of the remaining 55 patients selected for NOMLI, the method failed in 8 for reasons unrelated to the liver injury: 2 underwent a splenectomy, 1 underwent a nephrectomy, 1 had a small-bowel repair, 1 underwent abdominal decompression for abdominal compartment syndrome, and 3 underwent a nontherapeutic laparotomy. The success rate of NOMLI was 85% (47 of 55 patients), but the liver-specific success rate was 100%. Compared with those in whom NOMLI was successful, patients in whom it failed had a higher Injury Severity Score and underwent more blood transfusions, but they had similar liver injury grades. In total, 66 (85%) of liver injuries did not bleed significantly. No adverse events were attributed to NOMLI. CONCLUSIONS: Nonoperative management of liver injuries is safe and effective regardless of the grade of liver injury. Failure of NOMLI is caused by associated abdominal injuries and not the liver. Fluid and blood requirements, the degree of injury severity, and the presence of other abdominal organ injuries may help predict failure. PMID: 12742948
文献考察：２）鈍的肝損傷治療法と成績の変化．1995年以前と1995年以後を比較し，平均入院日数19.8日→9.1日，ICU入院日数15.2日→5.3日，輸血量10単位→4.2単位，手術例46％→30％，死亡率16.8%→11.3%．
Am Surg. 2004 Jan;70(1):45-8.
The evolving management of blunt hepatic trauma in a rural setting.
Somasundar PS, Mucha P, McFadden DW.
Over the past decade, a nonoperative approach toward the management of blunt hepatic trauma has become prevalent at most major urban trauma centers. To determine the applicability of the nonoperative approach in a rural setting, a 10-year retrospective review was conducted at a level I rural university-based trauma center. The Census Bureau defines ruralized areas to provide a better separation of urban and rural territory and population. A ruralized area is composed of one or more places and the adjacent surrounding territory that together have a maximum of 50,000 persons. West Virginia University is classified as a rural academic medical center and is situated in Morgantown, whose permanent population does not exceed 35,000. All patients with documented blunt hepatic trauma between July 1990 and June 2000 were identified and reviewed. To evaluate evolving trends, the patients were divided into two groups: group A (July 1, 1990-June 30, 1995) and group B (July 1, 1995-June 30, 2000). There were 236 patients with documented blunt hepatic trauma identified between July 1, 1990, and June 30, 2000). Overall, 70 per cent of patients were managed conservatively. When comparing the two groups, statistical significance was obtained in mean hospital length of stay (LOS) [19.8 days A vs. 9.1 days B (P
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