目的:探讨经导管肝动脉栓塞技术在创伤性肝破裂出血治疗中的价值。方法:回顾性分析我院2012年4月至2015年4月收治的57例创伤性肝破裂出血患者,依据治疗方法将这些患者随机分为两组,即研究组(n = 28)和对照组(n = 29)。介入组患者为经导管肝动脉栓塞技术及腹腔引流术治疗,对两组患者的术中输血量、术后住院时间及并发症发生情况进行统计分析。结果:和开放手术组相比,介入组患者的术中输血量明显较少(P < 0.05),术后住院时间明显较短(P < 0.05),术后并发症发生率35.7%显著低于对照组58.6% (P < 0.05)。结论:经导管肝动脉栓塞技术在创伤性肝破裂出血治疗中具有较高的应用价值,值得在临床推广。 Objective: To investigate the value of transcatheter hepatic arterial embolization in the treatment of traumatic hepatic rupture. Methods: 57 cases of patients with liver trauma bleeding who were treated in our hospital from April 2012 to April 2015 were selected. These patients were divided into two groups according to the treatment methods, namely the interventional therapy group (n = 28) and the open surgery group (n = 29). The interventional therapy group of patients were given transcatheter hepatic arterial embolization therapy and peritoneal drainage, and then the intraoperative blood transfusion, postoperative hospital stay and complications of the two groups of patients were analyzed statistically. Results: The intraoperative blood transfusion of the interventional therapy group of patients was significantly less than that of the open surgery group (P < 0.05). Postoperative hospital stay was significantly shorter (P < 0.05). The postoperative complication rate 35.7% was significantly lower than that of the open surgery group 58.6% (P < 0.05). Conclusion: Transcatheter hepatic arterial embolization is an effective and safe method in the treatment of traumatic hepatic rupture; so it is worthy of promotion in the clinical.
经导管肝动脉栓塞技术,创伤性肝破裂出血,治疗,价值, Transcatheter Hepatic Arterial Embolization Traumatic Rupture of the Liver Treatment Value经导管肝动脉栓塞技术在创伤性肝破裂出血 治疗中的价值
改良Seldinger技术在肝动脉栓塞治疗中得到了充分利用,穿刺股动脉并插入 4F 或 5F 导管,造影前在肝动脉或腹腔动脉开口放置导管进行造影,从而清晰了解肝脏血管受累的部位及情况,然后超选择导管至出血血管分支后,用栓塞剂进行栓塞。之后重复造影确定出血情况及栓塞情况。栓塞剂为采用明胶海绵条块或颗粒,规格分别为1 mm × 1 mm × 5 mm和1~3 mm × 1~3 mm × 1~3 mm [7] 。在创伤性肝破裂出血的治疗中经动脉栓塞术较开放手术具有操作简单,止血及时肯定以及创伤小的优势,对开放手术及其术后并发症进行了有效的避免。在创伤性胆道出血的治疗中,一般治疗方法很难对出血进行彻底的控制,很多患者虽然接受了抗感染、输血等积极治疗,但是疗效仍然无法令人满意,开放手术是一种治疗方法,但是如果手术之前,无法明确出血部位,那么临床就很难进行手术探查,这就极大的增加了手术的危险性。在肝脏深部出血的治疗中,由于一般性开放手术甚至肝动脉结扎很难对出血进行有效的控制,因此血管内栓塞治疗具有无比的优越性。选择行肝动脉栓塞具有损伤小、止血彻底等效果,在严重的肝破裂病例中也适合用介入治疗,因此在其治疗中得到了积极的应用 [8] - [10] 。