腹腔镜手术联合肝动脉栓塞治疗外伤性肝破裂患者临床疗效及影响预后因素分析

Clinical efficacy of laparoscopic surgery combined with transhepatic artery embolization for the treatment of patients with traumatic liver rupture

目的探讨腹腔镜手术联合选择性肝动脉栓塞(TAE)治疗外伤性肝破裂患者的临床疗效及术后感染发生的影响因素。方法 2015年5月～2018年6月我院收治的83例外伤性肝破裂患者,41例接受腹腔镜手术,42例接受腹腔镜手术联合TAE治疗。采用二元Logistic回归分析影响外伤性肝破裂患者术后感染发生的相关因素。结果在术后1 w,联合组患者有效止血率为90.5%,显著高于腹腔镜手术组患者的79.5%,差异有统计学意义(x^2=3.938,P<0.05);联合组发生术后感染3例(7.1%),腹腔镜手术组发生感染11例(26.8%),两组差异有统计学意义(x^2=5.734,P=0.017);单因素和多因素分析显示,肝损伤程度、术中出血量、手术时间、外周血白细胞计数、糖尿病和手术方法为外伤性肝破裂患者术后感染发生的危险因素(P<0.05)。结论采用腹腔镜手术联合TAE治疗肝破裂出血患者止血有效率较高,针对合适的患者采用联合手术方案,能提高治疗效果。

Objective To investigate the clinical efficacy of laparoscopic surgery combined with transhepatic artery embolization(TAE) for the treatment of patients with traumatic liver rupture. Methods 83 patients with traumatic liver rupture were admitted to our hospital between May 2015 and June 2018,and 41 received laparoscopic surgery,and 42 received laparoscopic surgery combined with TAE. Logistic regression analysis was applied to analyze the risk factors affecting postoperative infection in patients with traumatic liver rupture. Results At the end of one week post-operation,the hemostatic rate in combination group was 90.5%,significantly higher than 79.5% in laparoscopic surgery group (x^2=3.938,P<0.05);the incidence of postoperative abdominal infection occurred in 3 cases (7.1%) in the combined group,significantly lower than in 11 cases (26.8%) in the laparoscopic group (x^2=5.734,P<0.05);univariate and multivariate analysis showed that the degree of liver injury,intraoperative blood loss,operation time,white blood cell counts,diabetes mellitus and surgery were the risk factors affecting post-operative infection in patients with traumatic liver rupture (P<0.05). Conclusion Laparoscopic surgery combined with TAE is effective in hemostasis of liver rupture,and it is an appropriate alternative for patients with traumatic liver rupture in emergency.