Empey Rebecca, Nirula Ram, Lombardo Sarah
Surgery, University of Utah Health, Salt Lake City, Utah, USA.
Trauma Surg Acute Care Open. 2025 Jan 22;10(1):e001627. doi: 10.1136/tsaco-2024-001627. eCollection 2025.
Management of traumatic liver injury includes observation, hemorrhage control laparotomy (HCL), and/or liver angioembolization (LAE). Although the literature supports LAE as an effective option, procedure-related complications are well described and not uncommon. The purpose of this study is to evaluate whether LAE is associated with worse outcomes in both patients undergoing HCL and patients managed expectantly.
This is a retrospective analysis of patients with grades III to V traumatic liver injury enrolled in the 2018 to 2020 Trauma Quality Improvement Program database. Two comparisons were performed: (1) HCL within 24 hours of admission with and without LAE, and (2) no HCL within 24 hours of admission with and without LAE. Propensity score matching was used to account for differences in patient acuity, and univariate analysis was performed to compare groups.
Both groups were well balanced after matching. Among patients with initial HCL, concomitant LAE did not affect mortality, length of stay, or complications. Patients with LAE underwent more percutaneous liver drainage procedures (7.8% vs. 3.3%, p=0.016). In the second comparison, LAE was associated with a statistically significant increase in hospital length of stay (17.6 days vs. 14.2 days, p<0.001) and more percutaneous liver drainage procedures (4.3% vs. 0.8%, p=0.002) but less open liver repairs (3.5% vs. 8.3%, p=0.004). For both cohorts, patients undergoing LAE had significantly higher 4-hour transfusion volumes.
LAE following traumatic liver injury is associated with more percutaneous liver drainage procedures. It is associated with increased hospital length of stay when compared with patients who are managed expectantly, but does not significantly affect mortality or hospital complications. Although the literature reports a high rate of liver-related complications, we found a relatively lower rate of liver-related interventions, particularly in the non-operative group.
III.
创伤性肝损伤的治疗方法包括观察、出血控制剖腹术（HCL）和/或肝血管栓塞术（LAE）。尽管文献支持LAE是一种有效的选择，但与该手术相关的并发症已有详细描述且并不罕见。本研究的目的是评估LAE在接受HCL的患者和采取保守治疗的患者中是否与更差的预后相关。
这是一项对2018年至2020年创伤质量改进计划数据库中III至V级创伤性肝损伤患者的回顾性分析。进行了两项比较：（1）入院24小时内接受HCL且接受或未接受LAE的患者，以及（2）入院24小时内未接受HCL且接受或未接受LAE的患者。采用倾向评分匹配法来考虑患者病情严重程度的差异，并进行单因素分析以比较各组。
匹配后两组情况良好。在最初接受HCL的患者中，同时进行LAE并不影响死亡率、住院时间或并发症。接受LAE的患者接受经皮肝穿刺引流术的比例更高（7.8%对3.3%，p = 0.016）。在第二项比较中，LAE与住院时间显著延长（17.6天对14.2天，p < 0.001）以及更多的经皮肝穿刺引流术（4.3%对0.8%，p = 0.002）相关，但开放性肝修复术较少（3.5%对8.3%，p = 0.004）。对于这两个队列，接受LAE的患者4小时输血量显著更高。
创伤性肝损伤后进行LAE与更多的经皮肝穿刺引流术相关。与采取保守治疗的患者相比，它与住院时间延长相关，但对死亡率或医院并发症没有显著影响。尽管文献报道肝相关并发症发生率较高，但我们发现肝相关干预措施的发生率相对较低，尤其是在非手术组。
III级
