急诊动脉介入栓塞术在交通伤救治中的应用

Clinical application of emergency transcatheter arterial embolization in treatment of traffic injuries

目的 研究急诊动脉介入栓塞术（TAE）在交通伤救治中的临床应用价值及运作方式。方法 采用Seldinger法急诊行TAE治疗交通伤所致脾破裂、肾破裂、肝破裂及颅底骨折鼻出血、肺挫伤气管出血、骨盆骨折等共57例，包括颈外动脉3例，颌内动脉2例，上颌动脉2例，髂内动脉11例，肝动脉10例，肝右动脉7例，脾动脉28例，胃左动脉1例，肾动脉7例，支气管动脉2例，会阴部动脉1例，腰椎动脉1例，右膈动脉1例。其中栓塞脏器或部位计单个44例，2个13例次，3个2例。结果 手术时间30min～2h，平均45min。导管造影诊断率为100％。一次栓塞成功52例，成功率为95％；经二次栓塞成功2例，失败1例，总成功率为98％。抢救生存52例，抢救成功率为91％。术后并发腹股沟血肿3例，发生率为5％。结论 急诊一体化模式实施TAE救治交通伤患者能明显缩短救治时间，提高救治成功率，具有临床应用价值。

Objective To evaluate the clinical effect and mechanism of emergency transcatheter arterial embolization （TAE） in treatment of traffic injuries. Methods TAE was performed in 57 patients with traffic injury induced symptoms including splenic rupture, kidney rupture, hepatorrhexis, nasal cavity bleeding with basal fracture, trachea hemorrhage with pulmonary contusion and pelvic frac- tures. There were 3 patients with external carotid artery, 2 with internal maxillary artery, 2 with maxillary artery, 11 with internal iliac artery, 10 with hepatic artery, 6 with right hepatic arteria, 27 with splenic artery, 1 with left gastric artery, 6 with renal artery, 2 with bronchial artery, 1 with internal pudendal artery, 1 with vertebral artery and 1 with right arteria phrenica. Of all, 43 patients were embolized at one part, 12 at two parts and 2 at three parts. Angiography was performed in 2 patients. Results The operation lasted for from 30 minutes to 2 hours （ average 45 minutes）. All 57 patients with active bleeding were identified by angiography, with successful diagnosis rate of 100%. Fity-five patients were treated with embolization, of which 52 patients＇ bleeding was controlled immediately after the first embolization, with success rate of 94.5% ; the other 2 patients received second embolization and one failed, with total success rate of 98.2%. There were 52 patients survived, with success rate of 91.2%. After operation, hematoma of the fold inguen occurred in 3 patients, with an incidence rate of 5.3%. Conclusion TAE can shorten the treatment period, improve the success rate of treatment and hence has a good prospact of clinical application.