Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, 5 Fu-Hsin Street, Gueishan, Taoyuan, 333, Taiwan.
Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
Sci Rep. 2020 Nov 12;10(1):19612. doi: 10.1038/s41598-020-76618-w.
Massive hepatic necrosis after therapeutic embolization has been reported. We employed a 320-detector CT scanner to compare liver perfusion differences between blunt liver trauma patients treated with embolization and observation. This prospective study with informed consent was approved by institution review board. From January 2013 to December 2016, we enrolled 16 major liver trauma patients (6 women, 10 men; mean age 34.9 ± 12.8 years) who fulfilled inclusion criteria. Liver CT perfusion parameters were calculated by a two-input maximum slope model. Of 16 patients, 9 received embolization and 7 received observation. Among 9 patients of embolization group, their arterial perfusion (78.1 ± 69.3 versus 163.1 ± 134.3 mL/min/100 mL, p = 0.011) and portal venous perfusion (74.4 ± 53.0 versus 160.9 ± 140.8 mL/min/100 mL, p = 0.008) were significantly lower at traumatic parenchyma than at non-traumatic parenchyma. Among 7 patients of observation group, only portal venous perfusion was significantly lower at traumatic parenchyma than non-traumatic parenchyma (132.1 ± 127.1 vs. 231.1 ± 174.4 mL/min/100 mL, p = 0.018). The perfusion index between groups did not differ. None had massive hepatic necrosis. They were not different in age, injury severity score and injury grades. Therefore, reduction of both arterial and portal venous perfusion can occur when therapeutic embolization was performed in preexisting major liver trauma, but hepatic perfusion index may not be compromised.
据报道，在进行治疗性栓塞后会发生大量肝坏死。我们使用了一台 320 探测器 CT 扫描仪来比较接受栓塞和观察治疗的钝性肝外伤患者的肝灌注差异。这项有知情同意的前瞻性研究得到了机构审查委员会的批准。从 2013 年 1 月至 2016 年 12 月，我们共纳入了 16 名符合纳入标准的严重肝外伤患者（6 名女性，10 名男性；平均年龄 34.9±12.8 岁）。通过双输入最大斜率模型计算肝 CT 灌注参数。在 16 名患者中，9 名接受了栓塞治疗，7 名接受了观察治疗。在栓塞组的 9 名患者中，其创伤实质的动脉灌注（78.1±69.3 与 163.1±134.3 mL/min/100 mL，p=0.011）和门静脉灌注（74.4±53.0 与 160.9±140.8 mL/min/100 mL，p=0.008）明显低于非创伤实质。在观察组的 7 名患者中，只有创伤实质的门静脉灌注明显低于非创伤实质（132.1±127.1 与 231.1±174.4 mL/min/100 mL，p=0.018）。两组之间的灌注指数没有差异。没有患者发生大量肝坏死。两组患者的年龄、损伤严重程度评分和损伤等级均无差异。因此，在存在严重肝外伤的情况下进行治疗性栓塞时，可能会同时出现动脉和门静脉灌注减少，但肝灌注指数可能不会受到影响。
