介入技术在治疗多发伤合并腹部实质性脏器损伤中的价值

The value of interventional therapy in the treatment of multiple trauma with abdominal solid organ injury

目的探讨介入栓塞技术治疗多发伤合并腹部实质性脏器损伤患者的价值。方法回顾性分析2012年7月—2016年7月治疗的50例多发伤合并有腹部实质性脏器损伤患者,平均年龄(39.6±11.6)岁,其中单纯肝脏损伤15例、脾损伤18例、肾损伤6例;两个实质脏器损伤11例。根据其治疗方式的不同,分为介入栓塞止血治疗的试验组(25例)和行传统剖腹手术止血的对照组(25例)。结果两组患者均止血彻底,试验组平均手术时间(53.8±7.9)min,平均输血量(612.0±176.9)m L,平均住院时间(18.9±3.2)d,未出现并发症及再次手术情况。对照组平均手术时间(57.8±61.5)min,平均输血量约(904.0±356.5)m L,平均住院时间(24.5±9.7)d。共出现并发症2例,其中1例肝脓肿,1例胆漏,经再次手术治疗痊愈。两组手术时间、平均住院时间、输血量、术后并发症及再次手术次数比较,试验组明显少于对照组(P<0.05),差异有统计学意义。结论介入栓塞技术是治疗多发伤合并腹部实质性脏器损伤的有效措施,符合损害控制原理,具有创伤小、恢复快的特点,能有效减少患者输血量、并发症,提高多发伤救治成功率。

Objective To explore the value of interventional embolization in the treatment of multiple trauma with abdominal solid organ injury.Methods A retrospective analysis was conducted in 50 cases of multiple trauma with abdominal parenchymal organ injury treated in our department from Jul.2012 to Jul.2016.The mean age was(39.6±11.6)years.There were 15 cases of pure liver injury,18 cases of splenic injury and 6 cases of renal injury.Two parenchymal organs were injured in 11 cases.According to the different methods of the treatment,they were divided into experimental group(25 cases)who were treated with hepatic interventional embolization and control group(25 cases)who were treated with conventional laparotomy.Results Bleeding was controlled thoroughly in the two groups.In the experimental group,the average operation time was(53.8±7.9)minutes,the average blood transfusion volume was(612.0±176.9)mL,the average length of stay was(18.9±3.2)days,and no complications and reoperation were observed.The control group had an average operation time of(57.8±61.5)minutes,an average blood transfusion volume of(904.0±356.5)mL,and an average hospital stay of(24.5±9.7)day.Two cases occurred complications,including 1 case of liver abscess and 1 case of bile leakage,which were cured by reoperation.The operation time,average hospital stay,blood transfusion volume,postoperative complications and reoperation frequency of the two groups were significantly lower than those of the control group(P<0.05),and the difference was statistically significant.Conclusion Interventional embolization is an effective method for the treatment of multiple trauma with abdominal parenchymal organ hemorrhage.It accords with the principle of damage control,has the characteristics of small trauma and rapid recovery and can effectively reduce the blood transfusion volume and complications,and hence improving the success rate of treatment of multiple trauma.