School of Medicine, China Medical University, Taichung, Taiwan.
Am J Surg. 2012 Apr;203(4):448-53. doi: 10.1016/j.amjsurg.2011.01.031. Epub 2011 Jul 26.
Nonoperative management (NOM) has become the standard treatment of blunt hepatic injury (BHI) for stable patients. Contrast extravasation (CE) on computed tomography (CT) scan had been reported as a sign that is associated with NOM failure. The goal of this study was to further investigate the risk factors of NOM failure in patients with CE on CT scan.
From January 2005 to September 2009, patients with CE noted on a CT scan as a result of BHI were studied retrospectively. Physiological parameters, severity of injury, amount of transfusion, type of contrast extravasation, as well as treatment outcome were compared between patients with NOM failure and NOM success.
A total of 130 patients were enrolled. Injury severity scores, amount of blood transfusion before hemostatic procedure, and grade of liver injury were significantly higher in NOM failure than in NOM success patients. There was no statistical difference in the NOM success rate between patients with contrast leakage into the peritoneum and those with contrast confined in the hepatic parenchyma.
Higher injury severity score, more blood transfusion, and higher grade of liver injury are factors that correlate with NOM failure in patients with BHI. Contrast leakage into the peritoneum is not always a definite sign of NOM failure in BHI. Early and aggressive angioembolization is an effective adjunct of NOM in BHI patients, even with contrast leakage into peritoneum.
非手术治疗（NOM）已成为稳定型钝性肝损伤（BHI）的标准治疗方法。CT 扫描上的对比外渗（CE）曾被报道为与 NOM 失败相关的标志。本研究的目的是进一步探讨 CT 扫描上有 CE 的患者 NOM 失败的危险因素。
回顾性研究 2005 年 1 月至 2009 年 9 月因 BHI 导致 CT 扫描上有 CE 的患者。比较 NOM 失败和 NOM 成功患者的生理参数、损伤严重程度、输血量、CE 类型以及治疗结果。
共纳入 130 例患者。NOM 失败患者的损伤严重程度评分、止血术前输血量和肝损伤分级明显高于 NOM 成功患者。CE 渗漏至腹膜与局限于肝实质的患者 NOM 成功率无统计学差异。
较高的损伤严重程度评分、较多的输血和较高的肝损伤分级是 BHI 患者 NOM 失败的相关因素。CE 渗漏至腹膜并不总是 BHI 中 NOM 失败的明确标志。早期积极的血管栓塞术是 BHI 患者 NOM 的有效辅助手段，即使有腹膜 CE 渗漏。
