Radiology Department, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China.
Trauma Centre and Critical Care Medicine, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China.
Eur J Trauma Emerg Surg. 2023 Aug;49(4):1751-1761. doi: 10.1007/s00068-022-02054-2. Epub 2022 Jul 19.
The objective of the present study is to provide a comprehensive review of the literature on associated outcomes of angioembolization in blunt abdominal solid organ traumas.
The databases of Medline, Embase, and Cochrane Library were explored until 24 September 2021. All studies with data on the efficacy or safety of angioembolization in patients suffering from hemodynamically unstable blunt abdominal solid organ trauma were included. The primary outcomes were clinical success rate and mortality. Pooled event rates were calculated using a double arcsine transformation to stabilize the variance of the original proportion.
In total, 13 reports of 12 studies were included in the systematic review. According to the current meta-analysis, the angioembolization for blunt abdominal solid organ trauma in hemodynamically unstable patients had a high clinical success rate [0.97 (95% CI 0.93-0.99)] and low mortality [0.03 (95% CI 0.01-0.07)]. Furthermore, no statistically significant difference was found between the various injured solid organs for either of these parameters. In addition, the technique-associated adverse events were seldom and tolerable.
For blunt abdominal solid organ trauma in hemodynamically unstable patients, this review shows that angioembolization exhibited a high clinical success rate, low mortality, and tolerable technique-related adverse events. Furthermore, the top possible indication for angioembolization in hemodynamically unstable patients is an individual who responds to rapid fluid resuscitation. However, high-quality and large-scale trials are needed to confirm these results and determine the selection criteria for appropriate patients in this setting.
本研究旨在对血管栓塞治疗钝性腹部实质脏器创伤的相关结局进行全面综述。
检索 Medline、Embase 和 Cochrane 图书馆数据库，截至 2021 年 9 月 24 日。纳入所有关于血管栓塞治疗血流动力学不稳定的钝性腹部实质脏器创伤患者的疗效或安全性数据的研究。主要结局是临床成功率和死亡率。采用双反正弦变换对原始比例的方差进行稳定化处理，计算汇总事件率。
系统评价共纳入 12 项研究的 13 份报告。根据本次荟萃分析，血管栓塞治疗血流动力学不稳定的钝性腹部实质脏器创伤的临床成功率高[0.97（95%置信区间 0.93-0.99）]，死亡率低[0.03（95%置信区间 0.01-0.07）]。此外，对于这两个参数，不同受伤的实质脏器之间没有统计学意义上的差异。此外，该技术相关的不良事件很少且可耐受。
对于血流动力学不稳定的钝性腹部实质脏器创伤患者，本综述表明血管栓塞治疗具有较高的临床成功率、较低的死亡率和可耐受的技术相关不良事件。此外，血管栓塞治疗血流动力学不稳定患者的最佳适应证可能是对快速液体复苏有反应的个体。然而，需要高质量和大规模的试验来证实这些结果，并确定该情况下适合患者的选择标准。
