Degree-central

IV-crush, compression of the parenchyma, areas of necrosis and damage to the hepatic veins and portal vein.

Currently, the international distribution of the classification of liver damage was suggested in 1986 by E. Moore and formally adopted by the American Association of trauma surgeons principles laid down in this classification, similar to the principles of classification, VS Shapkina and JA Grinenko. It takes into account not only the morphology of the private damages and injuries of the liver, but also the dynamics of the injuries that do not require surgical treatment. In addition, the author has succeeded in one classification to combine features of a closed trauma and injuries of the liver. In 1996, she was somewhat detailed, it was introduced code ICD 9 th revision (864, 01-14) and scores the severity of the patient but the scale of AIS (from 2 to 6) [6].

This classification is as follows:

Grade I-subcapsular hematoma is stable, which occupies at least 10% of the surface and the wound depth at least 1 cm with no bleeding, 2 points;

Grade II-subcapsular hematoma is stable, which brand viagra online occupies 10-50% of the surface, a central, stable at least 2 cm in diameter and wound depth of less than 3 cm, length 10 cm, bleeding, 2 points;

Grade III - subcapsular hematoma is stable for more than 50% of the surface, or subcapsular unstable of any diameter, or podkapsusulnaya with rupture and hemorrhage, or central stable for more brand name levitra than 2 cm in diameter, or center unstable of any size and the wound deeper than 3 cm-3 points;

IV degree-central hematoma with rupture and bleeding and destruction of the parenchyma in the 25-50% interest, or from 1 to 3 segments of 4 points;

V-degree of destruction of the share of more than 50% or more than 3 segments and yukstapechenochnye vascular damage, 5 points;

VI degree-vascular lesions with a margin of liver, 6 points.

We believe it inappropriate to allocate the severity of a predetermined combination of violations, while in practice their combination can be varied. In addition to the existing classifications do not differentiate not only the severity of damage to extrahepatic vessels and ligaments, but often do not even take into account these parameters. An important, we believe, and an indication, along with the size of damage to the safety or violating the integrity of the hepatic capsule. Most appropriate, we assume the total assessment of the severity of damage to several groups of symptoms, taking into account every single one of them and for each degree to take this one does not score, but a certain segment, which will include a sum of points obtained in the comprehensive assessment. H. Patcher believes that in patients with concomitant injury severity of liver damage should be overestimated by one unit and damages I, II and III degree of damage to consider II, III and IV.

It should be emphasized that some of the details of this classification by different authors differ. The same H. Patcher to III degree include central hematoma of more than 10 cm in diameter, while N.L. Mischinger - more than 2 cm in diameter. However, these differences are not fundamental. The important thing is that this classification is specific to liver damage and foreign literature of the last decade to discuss the problems of liver injury occurs with reference to the severity of the damage on E. Moore. Important is that it generic levitra takes into account the condition of the liver, regardless of hirurgicheskgo intervention that allows us to estimate the dynamics of traumatic disease in the course of conservative treatment.

For practical use, in our opinion, the most efficient is the combination chetyrehstepennoy classification of liver injury proposed by Litvinova NA and Naydovym GI and classification by E. Moore. In our opinion, the latter very well considering the extent, type and morphology of the damage, while introducing ballroom system assessment of the severity of damage. Thus, if we take the above mentioned classification and take into account our view, the classification of liver injury and its numerical score is as follows.

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