经导管动脉内栓塞术与剖腹手术治疗严重肝外伤的疗效比较  

Efficacy of transcatheter arterial embolization and laparotomy in the treatment of severe liver injury:a comparative study

作　　者：叶磊 聂凯 李冉冉 陈达丰 张文华 陈永艺 薛小军 王少怡 刘建平 钟伟[1] 周松 Ye Lei;Nie Kai;Li Ranran;Chen Dafeng;Zhang Wenhua;Chen Yongyi;Xue Xiaojun;Wang Shaoyi;Liu Jianping;Zhong Wei;Zhou Song(Department of General Surgery,909th Hospital of Joint Logistics Support Force(Affiliated Dongnan Hospital of Xiamen University Medical College),Zhangzhou 363000,China;Department of Breast and Thyroid Surgery,Huangshi Central Hospital(Afiliated Hospital of Hubei Polytechnic University),Edong Healthcare Group,Huangshi 435000,China)

机构地区：[1]联勤保障部队第九〇九医院(厦门大学医学院附属东南医院)普通外科,漳州363000 [2]鄂东医疗集团黄石市中心医院(湖北理工学院附属医院)乳腺甲状腺外科,黄石435000

出　　处：《中华创伤杂志》2022年第11期1012-1019,共8页Chinese Journal of Trauma

基　　金：福建省自然科学基金(2020J01133)。

摘　　要：目的比较经导管动脉内栓塞术(TAE)与剖腹手术治疗严重肝外伤的疗效。方法采用回顾性队列研究分析2013年12月至2020年6月联勤保障部队第九〇九医院(厦门大学医学院附属东南医院)收治的48例严重肝外伤患者临床资料,其中男28例,女20例;年龄16~75岁[(45.7±6.2)岁]。美国创伤外科学会(AAST)分级Ⅲ级25例,Ⅳ级15例,Ⅴ级8例。患者经扩容、止血等一般救治后,26例行TAE治疗(TAE组),22例行剖腹手术(剖腹组)。比较两组手术时间、住院时间;术前及术后1 d红细胞、血红蛋白、血肌酐水平;术前及术后1,3,7 d血清谷丙转氨酶(ALT)、谷草转氨酶(AST)水平;并发症发生情况。结果患者均获随访12~60个月[(17.1±9.1)个月]。TAE组手术时间为(65.7±9.2)min,住院时间为(21.6±6.6)d,显著短于剖腹组的(162.5±28.1)min、(31.5±7.4)d(P<0.05或0.01)。两组术前及术后1 d红细胞、血红蛋白、血肌酐水平差异无统计学意义(P均>0.05)。两组术前ALT、AST差异无统计学意义(P均>0.05)。术后1,3,7 d TAE组血清ALT分别为1154(884,1698)U/L、(975.3±400.9)U/L、(403.4±232.9)U/L,显著低于剖腹组的2053(1965,2132)U/L、(1604.1±188.2)U/L、(915.3±160.5)U/L;AST分别为(1313.2±542.0)U/L、525(302,971)U/L、174(84,324)U/L,显著低于剖腹组的(1962.9±245.4)U/L、1478(1089,1677)U/L、837(674,1006)U/L(P<0.05或0.01)。TAE组并发症发生率为26.9%(7/26),显著低于剖腹组的59.1%(13/22)(P<0.05)。结论对于严重肝外伤,TAE较剖腹手术能显著缩短手术时间和住院时间,肝功能恢复快,并发症发生率低。Objective:To compare the efficacy of transcatheter arterial embolization(TAE)with laparotomy in the treatment of severe liver injury.Methods:A retrospective cohort study was conducted to analyze the clinical data of 48 patients with severe liver injury admitted to 909th Hospital of Joint Logistics Support Force(Affiliated Dongnan Hospital of Xianmen University Medical College)from December 2013 to June 2020,including 28 males and 20 females;aged 16-75 years[(45.7±6.2)years].There were 25 patients with grade III,15 grade IV and 8 grade V according to the American Association for the Surgery of Trauma(AAST)classification.After general treatments such as infusion and hemostasis,TAE was performed in 26 patients(TAE group)and laparotomy in 22 patients(laparotomy group).The operation time and length of hospital stay were compared between the two groups.Erythrocyte,hemoglobin and serum creatinine were compared before operation and at postoperative 1 day.Alanine aminotransferase(ALT)and aspartate aminotransferase(AST)were analyzed before operation and at postoperative 1,3,7 days.Complications were observed.Results:All patients were followed up for 12-60 months[(17.1±9.1)months].The operation time and length of hospital stay were(65.7±9.2)minutes and(21.6±6.6)days in TAE group,significantly shorter than(162.5±28.1)minutes and(31.5±7.4)days in laparotomy group(P<0.05 or 0.01).There was no significant difference between the two groups referring to erythrocyte,hemoglobin and serum creatinine before operation and at postoperative 1 day(all P>0.05).There was no significant difference in ALT and AST between the two groups before operation(all P>0.05).TAE group showed ALT level of 1154(884,1698)U/L,(975.3±400.9)U/L and(403.4±232.9)U/L at postoperative 1,3,7 days,significantly lower than 2053(1965,2132)U/L,(1604.1±188.2)U/L and(915.3±160.5)U/L in laparotomy group(all P<0.05).TAE group showed AST level of(1313.2±542.0)U/L,525(302,971)U/L and 174(84,324)U/L at postoperative 1,3,7 days,significantly lower than(1962.9±245

关 键 词：肝 腹部损伤 介入放射学 经导管动脉内栓塞术 

分 类 号：R657.3[医药卫生—外科学]