Nijhof H W, Willemssen F E J A, Jukema G N
Section of Traumatology, Department of Surgery, Leiden University Medical Center, P.O. Box 9600, 2300, RC Leiden, The Netherlands.
Emerg Radiol. 2006 Mar;12(3):111-5. doi: 10.1007/s10140-005-0460-x. Epub 2005 Dec 23.
The prevalence of liver injury in patients who have sustained blunt multiple trauma was reported to range from 1 to 8%. Because previous mortality rates were as high as 50-80% for severe hepatic injury, the choice of treatment was under intensive investigation. Whereas nonsurgical management was the standard treatment for the hemodynamically stable patient, there is no consensus on how to treat hemodynamically unstable patients. This report details the case of a patient who sustained blunt multiple trauma, resulting in a grade IV liver injury, graded according to the American Association for the Surgery of Trauma (AAST) Liver Injury Scale. With massive fluid and blood resuscitation, the patient was stable enough to be managed nonsurgically. With transcatheter arterial embolization (TAE), the left and right hepatic arteries were embolized with coils, which allowed for a good recovery. We hypothesize that TAE can be used in the hemodynamically unstable patient who responds to rapid fluid resuscitation and blood transfusion. We caution that there is insufficient evidence until now and would therefore not make any recommendations; however, we would question the need for surgery in unstable patients with this kind of injury in the future.
据报道，钝性多发伤患者肝损伤的发生率为1%至8%。由于既往严重肝损伤的死亡率高达50%-80%，因此治疗方法的选择受到了深入研究。对于血流动力学稳定的患者，非手术治疗是标准治疗方法，但对于血流动力学不稳定的患者如何治疗尚无共识。本报告详细介绍了一名钝性多发伤患者的病例，该患者导致了根据美国创伤外科协会（AAST）肝损伤分级标准为IV级的肝损伤。经过大量液体和血液复苏，患者病情稳定到足以进行非手术治疗。通过经导管动脉栓塞术（TAE），用弹簧圈栓塞了左右肝动脉，患者恢复良好。我们推测TAE可用于对快速液体复苏和输血有反应的血流动力学不稳定患者。我们提醒，目前证据不足，因此不会提出任何建议；然而，我们质疑未来对于这类损伤的不稳定患者是否有必要进行手术。
