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Resumen
El tratamiento conservador no operatorio se ha convertido en la actualidad en la mejor opción terapéutica de la mayoría de los traumatismos hepáticos cerrados en pacientes hemodinámicamente estables. Sin embargo, todavía hay dudas acerca de qué pacientes deben ser tratados de forma conservadora, si se puede predecir el fallo del tratamiento antes de que aparezcan las complicaciones y cómo debe hacerse el seguimiento de estos pacientes.
El presente estudio de revisión trata de establecer los criterios de selección de los pacientes teniendo en cuenta su estabilidad hemodinámica, su integridad neurológica, la presencia de signos peritoneales, el grado de la lesión, la posibilidad de controlar adecuadamente a los pacientes, la cantidad de hemoperitoneo, la cantidad de transfusión sanguínea, la presencia de lesiones asociadas, la calidad de la tomografía computarizada, la ausencia de hemorragia activa, la edad, la terapia anticoagulante y la etiología del traumatismo.
En la actualidad se dispone de suficientes datos que sugieren que es razonable realizar un tratamiento no operatorio de los traumatismos hepáticos cerrados tras haberse demostrado su eficacia en diferentes estudios, lo que en muchas ocasiones evita una laparotomía en blanco y precisa una menor cantidad de transfusión sanguínea, así como una estancia hospitalaria y en la unidad de cuidados intensivos (UCI) más reducida.
Se revisa también el control y el seguimiento de los pacientes y se discute cuánto tiempo deben permanecer en la UCI, ingresados, en cama o sin hacer ninguna actividad física importante, así como cada cuánto tiempo deben realizarse pruebas radiológicas.
En pacientes estables, la mayoría de los traumatismos hepáticos cerrados pueden ser tratados de forma conservadora con una baja morbimortalidad.
Palabras clave:
Traumatismo hepático
Hemoperitoneo
Embolización hepática
Currently, nonoperative conservative management is the best therapeutic option in most blunt liver trauma in hemodynamically stable patients. However, there are still doubts concerning whether patients should be managed conservatively, whether treatment failure can be predicted before the onset of complications and how these patients should be followed-up.
The present review aims to establish patient selection criteria, taking into account their hemodynamic stability, neurological integrity, the presence or absence of peritoneal signs, grade of lesion, the possibility of adequate monitoring, quantity of hemoperitoneum, quantity of blood transfusion, the presence of associated lesions, computed tomography quality, absence of active hemorrhage, age, anticoagulant therapy and cause of trauma.
Currently, there are sufficient data to suggest that nonoperative management of blunt liver trauma is a reasonable option. Several studies have demonstrated the efficacy of this modality, which can often avoid negative findings on laparotomy and can reduce blood transfusion requirements and length of hospital and intensive care unit (ICU) stay.
The monitoring and follow-up of patients are also reviewed. The length of time that patients should stay in the ICU and hospital, in bed or without significant physical activity and the frequency with which radiological tests should be performed are discussed.
In stable patients, most blunt liver trauma can be managed conservatively with low morbidity and mortality.
Key words:
Blunt liver trauma
Hemoperitoneum
Hepatic embolization
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