Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore.
J Pediatr Surg. 2012 Dec;47(12):2316-20. doi: 10.1016/j.jpedsurg.2012.09.050.
Non-operative management of isolated blunt hepatic trauma is recommended except when hemodynamic instability requires immediate laparotomy. Hepatic artery angioembolization is increasingly used for hepatic injuries with ongoing bleeding as demonstrated by contrast extravasation on the CT scan. It is used primarily or after laparotomy to control ongoing hemorrhage. Hepatic angioembolization as part of multimodality management of hepatic trauma is reported mainly in adults, with few pediatric case reports. We describe our institution experience with primary pediatric hepatic angioembolization and review the literature with regard to indications and complications. Two cases (3 and 8 years old), with high-grade blunt hepatic injuries with contrast extravasation on the CT scan were successfully managed by emergency primary hepatic angioembolization with minimal morbidity and avoided laparotomy. To date, the only reports of pediatric hepatic angioembolization for trauma are 5 cases for acute bleeding and 15 delayed cases for pseudoaneurysm. The role of hepatic angioembolization in the presence of an arterial blush on CT in adults is accepted, but contested in a pediatric series, despite higher transfusion rate and mortality rate. We propose that hepatic angioembolization should be considered adjunct treatment, in lieu of, or in addition to emergency laparotomy for hemostasis in pediatric blunt hepatic injury.
除非存在血流动力学不稳定需要立即剖腹探查，否则建议对孤立性钝性肝外伤进行非手术治疗。动脉血管造影栓塞术越来越多地用于持续出血的肝损伤，其依据是 CT 扫描上可见造影外渗。它主要用于剖腹探查前或剖腹探查后控制持续出血。肝血管造影栓塞术作为肝外伤多模式治疗的一部分，主要在成人中报道，而儿科病例报告较少。我们描述了我们机构在小儿原发性肝血管造影栓塞术方面的经验，并就适应证和并发症方面的文献进行了复习。2 例（3 岁和 8 岁）高分级钝性肝外伤，CT 扫描上可见造影外渗，通过急诊原发性肝血管造影栓塞术成功治疗，其发病率较低，避免了剖腹探查。迄今为止，小儿肝外伤血管造影栓塞术的唯一报道是 5 例急性出血病例和 15 例假性动脉瘤延迟病例。成人 CT 上存在动脉“红晕”时，血管造影栓塞术的作用已被接受，但在儿科系列中存在争议，尽管成人的输血率和死亡率较高。我们建议，对于小儿钝性肝损伤，在紧急剖腹探查止血的同时，或代替紧急剖腹探查，应考虑将肝血管造影栓塞术作为辅助治疗。
