Ptohis Nikolaos D, Charalampopoulos Georgios, Abou Ali Adham N, Avgerinos Efthymios D, Mousogianni Iliana, Filippiadis Dimitrios, Karydas George, Gravanis Miltiadis, Pagoni Stamatina
Department of Interventional Radiology, General Hospital of Athens "G. Gennimatas", Athens, Greece.
Second Department of Radiology, General University Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Front Surg. 2017 Aug 7;4:43. doi: 10.3389/fsurg.2017.00043. eCollection 2017.
Abdominopelvic trauma (APT) remains a leading cause of morbidity and mortality in the 15- to 44-year-old age group in the Western World. It can be life-threatening as abdominopelvic organs, specifically those in the retroperitoneal space, can bleed profusely. APT is divided into blunt and penetrating types. While surgery is notably considered as a definitive solution for bleeding control, it is not always the optimum treatment for the stabilization of a polytrauma patient. Over the past decades, there has been a shift toward more sophisticated strategies, such as non-operative management of abdominopelvic vascular trauma for haemodynamically stable patients. Angiographic embolization for bleeding control following blunt and/or penetrating intra- and retroperitoneal injuries has proven to be safe and effective. Embolization can achieve hemostasis and salvage organs without the morbidity of surgery, and the development and refinement of embolization techniques has widened the indications for non-operative treatment in solid organ injury. Moreover, advances in computed tomography provided more efficient scanning times with improved image quality. While surgery is still usually recommended for patients with penetrating injuries, non-operative management can be effectively used as well as an alternative treatment. We review indications, technical considerations, efficacy, and complication rates of angiographic embolization in APT.
在西方世界，腹部盆腔创伤（APT）仍是15至44岁年龄组发病和死亡的主要原因。它可能危及生命，因为腹部盆腔器官，特别是腹膜后间隙的器官，可能会大量出血。APT分为钝性和穿透性两类。虽然手术被公认为控制出血的最终解决方案，但它并不总是多创伤患者稳定病情的最佳治疗方法。在过去几十年中，已经转向更复杂的策略，例如对血流动力学稳定的患者采用非手术方法治疗腹部盆腔血管创伤。对于钝性和/或穿透性腹内和腹膜后损伤后控制出血的血管造影栓塞术已被证明是安全有效的。栓塞术可以实现止血并挽救器官，而不会产生手术的并发症，并且栓塞技术的发展和完善扩大了实体器官损伤非手术治疗的适应症。此外，计算机断层扫描技术的进步提供了更高效的扫描时间，图像质量也有所提高。虽然对于穿透性损伤患者通常仍建议进行手术，但非手术治疗也可以有效地用作替代治疗方法。我们回顾了血管造影栓塞术在APT中的适应症、技术要点、疗效和并发症发生率。
