From the Louisiana State University Health Sciences Center, New Orleans, LA (Deville, Marr, Smith).
University of Chicago School of Medicine, Chicago IL (Cone, Hoefer).
J Am Coll Surg. 2023 Nov 1;237(5):697-703. doi: 10.1097/XCS.0000000000000791. Epub 2023 Jun 27.
The management of major liver trauma continues to evolve in trauma centers across the US with increasing use of minimally invasive techniques. Data on the outcomes of these procedures remain minimal. The objective of this study was to evaluate patient complications after perioperative hepatic angioembolization as an adjunct to management of major operative liver trauma.
A retrospective multi-institutional study was performed at 13 level 1 and level 2 trauma centers from 2012 to 2021. Adult patients with major liver trauma (grade 3 and higher) requiring operative management were enrolled. Patients were divided into 2 groups: angioembolization (AE) and no angioembolization (NO AE). Univariate and multivariate analyses were performed.
A total of 442 patients were included with AE performed in 20.4% (n = 90 of 442) of patients. The AE group was associated with higher rates of biloma formation (p = 0.0007), intra-abdominal abscess (p = 0.04), pneumonia (p = 0.006), deep vein thrombosis (p = 0.0004), acute renal failure (p = 0.004), and acute respiratory distress syndrome (p = 0.0003), and it had longer ICU and hospital length of stay (p < 0.0001). On multivariate analysis, the AE had a significantly higher amount intra-abdominal abscess formation (odds ratio 1.9, 95% CI 1.01 to 3.6, p = 0.05).
This is one of the first multicenter studies comparing AE in specifically operative high-grade liver injuries and found that patients with liver injury that undergo AE in addition to surgery have higher rates of both intra- and extra-abdominal complications. This provides important information that can guide clinical management.
在美国各地的创伤中心，随着微创技术的应用越来越广泛，对重大肝外伤的处理方式也在不断演变。关于这些手术结果的数据仍然很少。本研究的目的是评估围手术期肝动脉栓塞术作为治疗严重手术性肝外伤的辅助手段对患者并发症的影响。
这是一项在 2012 年至 2021 年期间在 13 个 1 级和 2 级创伤中心进行的回顾性多中心研究。纳入了需要手术治疗的严重肝外伤（3 级及以上）的成年患者。患者分为两组：血管栓塞组（AE）和非血管栓塞组（NO AE）。进行了单变量和多变量分析。
共纳入 442 例患者，其中 20.4%（442 例中的 90 例）患者行血管栓塞术。AE 组胆漏形成率较高（p = 0.0007）、腹腔脓肿（p = 0.04）、肺炎（p = 0.006）、深静脉血栓形成（p = 0.0004）、急性肾衰竭（p = 0.004）和急性呼吸窘迫综合征（p = 0.0003）的发生率较高，ICU 和住院时间较长（p < 0.0001）。多变量分析显示，AE 组腹腔脓肿形成的风险显著更高（优势比 1.9，95%置信区间 1.01 至 3.6，p = 0.05）。
这是比较特定手术性高等级肝损伤中血管栓塞术的首批多中心研究之一，发现除手术外接受肝损伤血管栓塞术的患者有更高的腹腔内和腹腔外并发症发生率。这提供了重要信息，可以指导临床管理。
