选择性肝动脉栓塞治疗在闭合性肝损伤中的临床研究

Selective hepatic arterial embolization for blunt hepatic trauma

目的:探讨选择性肝动脉栓塞治疗创伤性闭合性肝脏破裂出血的临床价值。方法:回顾性分析2009年8月—2012年2月收治的61例闭合性肝脏破裂出血患者的临床资料,其中单纯的药物治疗30例(药物组),药物加介入栓塞治疗31例(介入组),比较两组中转手术率、人均输红细胞量、平均住院时间、并发症发生率。结果:入院时,两组患者性别、年龄及肝脏损伤程度差异无统计学意义(均P>0.05)。与药物组比较,介入组中转手术率(12.9%vs.30%),人均输红细胞量[(4.2±0.88)U vs.(6.6±1.47)U],平均住院时间[(7.2±5.2)d vs.(22.6±4.9)d]均明显减少(均P<0.05),但两组并发症发生率(19.4%vs.23.3%)差异无统计学意义(P>0.05)。结论:选择性肝动脉栓塞治疗创伤性闭合性肝脏破裂具有临床疗效稳定,创伤小,恢复快等优势,是一种较安全,有效的治疗措施。

Objective： To assess the clinical value of selective hepatic arterial embolization in the management of liver rupture and hemorrhage due to blunt hepatic injury. Methods： The clinical data of 61 patients with blunt liver rupture and hemorrhage treated during August 2009 to February 2012 were retrospectively analyzed.Of the patients,30 cases received medical therapy only（drug treatment group）,while the other 31 cases underwent medication and selective hepatic arterial embolization（interventional group）.The opertion conversion rate,average red blood cell transfusion per patient,average length of hospital stay and incidence of complications between the two groups were compared. Results： The differences in gender,age and degree of severity of liver injury between the two groups showed no statistical significance at admission（all P〈0.05）.Compared with drug treatment group,the operation conversion rate（12.9% vs.30%）,average red blood cell transfusion requirement [（4.2±0.88） U vs.（6.6±1.47） U] and length of hospital stay [（7.2±5.2） d vs.（22.6±4.9）d] in interventional group were decreased significantly（all P〈0.05）.No significant difference in incidence of complications between the two groups was noted（19.4% vs.23.3%）（P〈0.05）. Conclusion： Selective hepatic arterial embolization is a safe and effective treatment modality for liver rupture caused by blunt trauma,with the advantages of stable efficacy,minimal invasiveness and quick recovery.