[Reappraisal of hepatectomy in traumatic rupture of the liver]

From our experiences, the causes of high mortality rate in hepatectomy for hepatic rupture may be attributed to improper application of this procedure to trauma victims under suboptimal conditions, as most of the deaths were related to coagulopathy and uncontrollable bleeding. Accordingly, a protocol of indication for emergent hepatectomy was established in March, 1985, which included the following criteria: PH greater than 7.2, body temperature greater than 32.0 degrees C, systolic blood pressure greater than 60mmHg and no presence of coagulopathy. Of 14 cases which underwent hepatectomy before March, 1985, 9 cases died of exsanguination, coagulopathy and multiple organ failure with the mortality rate of 63.7% whereas only two of 10 cases which underwent hepatectomy after March, 1985, died, the mortality rate being markedly decreased to 20%. Considering the fact that there were no differences between these two groups of the patients regarding severity of liver trauma and clinical back ground, it indicates that the appropriate selection of the patients for hepatectomy based on the criteria has definitely decreased the mortality rate of hepatic rupture victims.