Ciraulo D L, Luk S, Palter M, Cowell V, Welch J, Cortes V, Orlando R, Banever T, Jacobs L
Department of Trauma/EMS, Hartford Hospital, Connecticut, USA.
J Trauma. 1998 Aug;45(2):353-8; discussion 358-9. doi: 10.1097/00005373-199808000-00025.
Recognizing the significant mortality and complications inherent in the operative management of blunt hepatic injuries, hepatic arterial embolization was evaluated as a bridge between operative and nonoperative interventions in patients defined as hemodynamically stable only with continuous resuscitation.
Seven of 11 patients with grade IV or V hepatic injuries identified by computed tomography underwent hepatic arterial embolization. A prospective evaluation of hepatic embolization based on subsequent hemodynamic parameters was assessed by matched-pair analysis. A summary of this study population's demographic data and outcomes is presented, including age, Glasgow Coma Scale score, Injury Severity Score, Revised Trauma Score, computed tomography grade, intensive care unit and hospital length of stay, transfusion requirements, complications, and mortality.
No statistical difference was demonstrated between pre-embolization and postembolization hemodynamics and volume requirements. After embolization, however, continuous resuscitation was successfully reduced to maintenance fluids. Hepatic embolization was the definitive therapy for all seven patients who underwent embolization.
Results of this preliminary investigation suggest that hepatic arterial embolization is a viable alternative bridging the therapeutic options of operative and nonoperative intervention for a subpopulation of patients with hepatic injury.
认识到钝性肝损伤手术治疗存在显著的死亡率和并发症，对仅通过持续复苏才定义为血流动力学稳定的患者，评估肝动脉栓塞作为手术和非手术干预之间的桥梁。
11例经计算机断层扫描确定为IV级或V级肝损伤的患者中有7例接受了肝动脉栓塞。通过配对分析对基于后续血流动力学参数的肝栓塞进行前瞻性评估。列出了该研究人群的人口统计学数据和结果总结，包括年龄、格拉斯哥昏迷量表评分、损伤严重度评分、修订创伤评分、计算机断层扫描分级、重症监护病房和住院时间、输血需求、并发症和死亡率。
栓塞前和栓塞后的血流动力学及容量需求之间未显示出统计学差异。然而，栓塞后，持续复苏成功减少至维持液量。肝栓塞是所有7例接受栓塞患者的确定性治疗方法。
这项初步调查结果表明，肝动脉栓塞是肝损伤患者亚群手术和非手术干预治疗选择之间的一种可行替代方法。
