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The liver is the largest parenchymal organ in the abdomen, and its texture is brittle.The incidence of penetrating injury in wartime or blunt injury in peacetime is the second and third place of abdominal visceral injury. Penetrating injury is next to small intestine injury, and blunt injury is next to spleen and small intestine injury.The liver is rich in blood supply and contains intrahepatic bile ducts, so a large amount of blood loss after injury leads to hemorrhagic shock, and a large amount of bile overflows into the abdominal cavity, causing biliary peritonitis, with a mortality rate of about 15-20%.
（2） Level II: superficial laceration or bullet penetrating wound less than 5cm, without bleeding.
（3） Grade III: small laceration or star shaped laceration of liver (Figure 20-2 (1)).
（4） Grade IV: One or two lobes of liver parenchyma were lacerated with massive hemorrhage (Figure 20-1 (2)).
（5） Grade V: extensive parenchymal lesion of liver with hepatic vein or liverArterial injury。
All injuries above grade III belong to severe liver injury, which accounts for about 30% of all liver injuries.
Diagnostic points
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（1） Abdominal pain: persistent severe pain in the right upper abdomen, radiating to the right shoulder and back, followed by total abdominal pain.
(II)Peritoneal irritation sign: Due to liver injury and intrahepatic bile duct rupture, bile stimulates peritoneum, with obvious abdominal tenderness, muscle tension and rebound pain.
（1） Hemostasis: For massive bleeding, finger pressure method or rubber tube tourniquet can be used as the liver hilum first（Hepatoduodenal ligament）Block the blood flow into the liver intermittently for no more than 15 minutes each time.Rapidly ligate the hepatic artery, portal vein branch and bile duct at the site of liver trauma.
（2） The dead liver tissue should be debridement first, leaving no necrotic tissue and dead space to avoid postoperative infectionBiliary hemorrhageOr liver abscess, and then suture.
（3） Use a round needle to thread catgut or No. 7 silk thread, and sew the wound intermittently. After the suture, apply
Knot, not too tight.
（4） Extensive liver parenchyma injury, which can be used for lobectomy debridement or irregularLobectomy of liver。
（5） For hepatic vein injury or retrohepatic inferior vena cava injury, if hepatic portal occlusion cannot stop the bleeding, it can be used to stop the bleeding by catheter in the inferior vena cava, and cut off part of the liver laceration, suture the hepatic vein and inferior vena cava
