2011 Volume 25 Issue 4 Pages 447-454
We changed treatment indications and modalities for severe hepatic injuries during the past 29 years. Hepatectomy was mainly undertaken during the early stage (1979-1984), the death rate of which was 64.3%. In the middle stage (1985-1994), the criteria for hepatectomy and use of adjunctive procedures were applied. The death rate of hepatectomy decreased, but outcomes for DCS and IIIb+JHV were poor. We considered that the circulatory state was more important than anatomical features of hepatic injuries and selected several treatment modalities such as hepatectomy, DCS and NOM during the late stage (1995-2007). The death rate in the late stage was decreased to 11.4%. Treatment modalities and outcomes for severe hepatic injuries have changed dramatically in the past 29 years. Multiple modes of therapy are available for hemorrhage control, which has improved outcomes. It is important to improve the death rate of DCS and IIIb+JHV in the future.
