Carrillo E H, Heniford B T, Senler S O, Dykes J R, Maniscalco S P, Richardson J D
Department of Surgery, University of Louisville School of Medicine, University of Louisville Hospital, Kentucky 40292, USA.
Am Surg. 1998 Dec;64(12):1142-8.
Hemothorax and persistent thoracic bleeding is frequently an indication for thoracotomy after trauma. Unfortunately, the source of the hemorrhage is often not identified. Presently, selective arteriography and transcatheter embolization (SATE) offers a good and safe alternative to localize and control hemorrhage from arterial injuries in selected patients. The records of eight patients who underwent SATE were reviewed. There were six blunt and two penetrating chest injuries. Four patients had significant preexisting medical comorbidities. Three patients with blunt injuries had undergone exploratory thoracotomy, but continued to bleed postoperatively. In three patients, angiography was indicated for associated thoracic and pelvic injuries, and five patients had SATE specifically due to thoracic hemorrhage. In all patients, SATE was effective to diagnose and control the hemorrhage. There were no complications related to the SATE procedure. Two patients died secondary to severe cerebral injuries. Given hemodynamic stability, SATE can be considered in patients who have already had a thoracotomy, have significant associated medical conditions, or those in need of other angiographic studies. Careful technique and a readiness to abandon SATE in unstable patients or when a suitable catheter position cannot be achieved are important technical points.
血胸和持续性胸腔出血常常是创伤后开胸手术的指征。不幸的是，出血源往往难以确定。目前，选择性动脉造影和经导管栓塞术（SATE）为特定患者定位和控制动脉损伤出血提供了一种安全有效的替代方法。回顾了8例接受SATE治疗患者的记录。其中6例为钝性胸部损伤，2例为穿透性胸部损伤。4例患者术前存在严重的内科合并症。3例钝性损伤患者接受了开胸探查术，但术后仍持续出血。3例患者因合并胸腹部损伤而行血管造影，5例患者因胸腔出血而专门接受SATE治疗。所有患者中，SATE均有效诊断并控制了出血。未发生与SATE操作相关的并发症。2例患者因严重脑损伤死亡。考虑到血流动力学稳定，对于已经接受过开胸手术、存在严重合并内科疾病或需要进行其他血管造影检查的患者，可考虑采用SATE。操作时技术要精细，对于不稳定患者或无法获得合适导管位置时要准备好放弃SATE，这些都是重要的技术要点。
