Resumen
Objetivo: Analizar las estrategias e intervenciones en el control de daños en traumatismos hepáticos, identificando enfoques eficaces y los principales desafíos en el manejo inicial y en las fases posteriores del tratamiento. Método: Revisión integrativa realizada mediante una búsqueda en la base de datos PubMed Central (PMC), incluyendo 13 artículos que abordan el control de daños en traumatismos hepáticos, publicados entre 2019 y 2024, en inglés y español. Resultados: El manejo no operativo (MNO) demostró ser eficaz, especialmente en pacientes hemodinámicamente estables y con lesiones hepáticas de menor gravedad, mostrando altas tasas de éxito y menor tiempo de hospitalización. Sin embargo, los casos graves (grado IV o V), hemoperitoneo significativo y la necesidad de angioembolización fueron factores asociados con un mayor riesgo de fallo del MNO, lo que indica la necesidad de intervención quirúrgica. La angioembolización y el taponamiento hepático surgieron como técnicas complementarias para controlar hemorragias y estabilizar a los pacientes. Conclusiones: El enfoque multidisciplinario e individualizado es esencial en el manejo del trauma hepático. El MNO es eficaz en la mayoría de los casos, pero la selección adecuada de los pacientes y la disponibilidad de estrategias adicionales son fundamentales para mejorar los resultados clínicos.
Referencias
ALANEZI T, et al. Management and Outcomes of Traumatic Liver Injury: A Retrospective Analysis from a Tertiary Care Center Experience. In: Healthcare. MDPI, 2024; 12(2): 131.
AYDIN O, et al. May dexpanthenol, platelet-rich plasma, and thymoquinone provide new hope to maintain liver regeneration after partial hepatectomy? The Turkish Journal of Gastroenterology, 2019; 30(9): 826.
BELTZER C, et al. Use of angioembolization, treatment modalities and mortality in association with blunt liver trauma in Germany—a data analysis of the TraumaRegister DGU®. Langenbeck's archives of surgery, 2023; 409(1): 6.
CARTU D, et al. Nonoperative treatment of abdominal trauma involving liver and spleen. Chirurgia, 2021; 116(6): 689-699.
DEL VALLE FJS, et al. Construction and validation of a novel and severe hepatic injury model in swine focuses on research and training. Observational study. MethodsX, 2023; 11: 102362.
FODOR M, et al. Non-operative management of blunt hepatic and splenic injury: a time-trend and outcome analysis over a period of 17 years. World Journal of Emergency Surgery, 2019; 14: 1-12.
GARCÍA IC, et al. Liver trauma: until when we have to delay surgery? A review. Life, 2022; 12(5): 694.
HOWLEY I, et al. Outcomes and complications for portal vein or superior mesenteric vein injury: no improvement in the era of damage control resuscitation. Injury, 2019; 50(12): 2228-2233.
HU W, et al. Accident-related hepatic trauma in a medical clinical center in eastern China: a cross-sectional study. BMC surgery, 2021; 21: 1-9.
KANANI A, et al. Management of severe liver injuries: push, pack, pringle–and plug!. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2021; 29: 1-4.
KEIZER AA, et al. Blunt and penetrating liver trauma have similar outcomes in the modern era. Scandinavian Journal of Surgery, 2021; 110(2): 208-213.
KRUGER A, et al. Damage control laparotomy outcomes in a major urban trauma centre. South African Journal of Surgery, 2022; 60(2): 84-90.
LIN BC, et al. Surgical management and outcome of blunt major liver injuries: experience of damage control laparotomy with perihepatic packing in one trauma centre. Injury, 2014; 45(1):122-127.
MALIK MM, et al. Delayed presentation of severe blunt liver trauma following a 12-foot fall: a case report of a grade 4 hepatic injury with a concurrent grade 1 renal injury. Cureus, 2024; 16(4).
ORDOÑEZ CA, et al. Damage control in penetrating liver trauma: fear of the unknown. Colombia Médica, 2020; 51(4).
PILLAI AS, et al. Hepatic trauma interventions. In: Seminars in interventional radiology. Thieme Medical Publishers, Inc., 2021; 38(1): 096-0104.
ROUY M, et al. Predictive factors of non-operative management failure in 494 blunt liver injuries: a multicenter retrospective study. Updates in Surgery, 2022; 74(6): 1901-1913.
RUSCELLI P, et al. The role of grade of injury in non-operative management of blunt hepatic and splenic trauma: Case series from a multicenter experience. Medicine, 2019; 98(35): e16746.
SCHEMBARI E, et al. Blunt liver trauma: effectiveness and evolution of non-operative management (NOM) in 145 consecutive cases. Updates in surgery, 2020; 72: 1065-1071.
STREITH L, et al. Optimal treatments for hepato-pancreato-biliary trauma in severely injured patients: a narrative scoping review. Canadian Journal of Surgery, 2020; 63(5): e431.
