Miura Naoya, Tsuchiya Asuka, Katsura Morihiro, Sakoda Naoki, Morita Seiji, Nakagawa Yoshihide
From the Department of Emergency and Critical Care Medicine (N.M., A.T., N.S., S.M., Y.N.), Tokai University School of Medicine, Isehara, Kanagawa; and Department of Surgery (M.K.), Okinawa Chubu Hospital, Uruma, Okinawa, Japan.
J Trauma Acute Care Surg. 2025 Aug 1;99(2):233-242. doi: 10.1097/TA.0000000000004640. Epub 2025 May 1.
Nonoperative management (NOM) is the standard of care for hemodynamically stable pediatric blunt liver and/or spleen injuries (BLSIs). The value of interventional radiology (IR) in NOM of pediatric BLSIs is not clearly established. This study aimed to describe the use and outcomes of IR in the management of pediatric BLSIs.
This post hoc analysis examined data from an 83-center retrospective study called the Splenic and Hepatic Injury in Pediatric Patients study in Japan. Participants included patients 16 years or younger who sustained BLSIs and received IR interventions between January 2008 and December 2019. The patients were categorized based on the indication for initial IR: acute hemorrhage, delayed hemorrhage/ruptured pseudoaneurysm, unruptured pseudoaneurysm, and others. The primary endpoint was IR failure, defined as requiring laparotomy after deciding for NOM with IR. Descriptive statistics were used to illustrate the baseline patient characteristics and IR treatment details.
Among the 1,462 pediatric patients with BLSIs, 316 patients who underwent IR were evaluated. The median patient age was 11 years, and 68% were male. Organ injuries included 176, 118, and 20 splenic, liver, and simultaneous injuries, respectively. Contrast extravasation on pre-IR computed tomography imaging was found in 60.6% of the patients. The median time to IR from admission varied by indication, with the acute hemorrhage group treated in approximately 2 hours. Transcatheter arterial embolization was performed in 273 patients. In-hospital complications occurred in 7%, with IR-related complications in 0.6%. Interventional radiology failed in 3.8% of the patients, and the in-hospital mortality rate was 1.9%. Splenic salvage was successful in 98.4% of the patients.
Interventional radiology demonstrated low failure and procedural complication rates in pediatric BLSIs.
Therapeutic/Care Management; Level IV.
非手术治疗（NOM）是血流动力学稳定的小儿钝性肝和/或脾损伤（BLSIs）的标准治疗方法。介入放射学（IR）在小儿BLSIs的非手术治疗中的价值尚未明确确立。本研究旨在描述IR在小儿BLSIs治疗中的应用及结果。
本事后分析检查了来自日本一项名为小儿患者脾和肝损伤研究的83中心回顾性研究的数据。参与者包括16岁及以下遭受BLSIs并在2008年1月至2019年12月期间接受IR干预的患者。患者根据初始IR的指征进行分类：急性出血、延迟出血/破裂假性动脉瘤、未破裂假性动脉瘤及其他。主要终点是IR失败，定义为在决定采用IR进行非手术治疗后需要剖腹手术。描述性统计用于说明患者基线特征和IR治疗细节。
在1462例小儿BLSIs患者中，对316例接受IR的患者进行了评估。患者中位年龄为11岁，68%为男性。器官损伤分别包括176例脾损伤、118例肝损伤和20例同时损伤。60.6%的患者在IR前计算机断层扫描成像中发现造影剂外渗。从入院到IR的中位时间因指征而异，急性出血组约在2小时内接受治疗。273例患者进行了经导管动脉栓塞术。7%的患者发生院内并发症，IR相关并发症为0.6%。3.8%的患者IR失败，院内死亡率为1.9%。98.4%的患者脾保留成功。
介入放射学在小儿BLSIs中显示出低失败率和低手术并发症发生率。
治疗/护理管理；IV级。
