选择性肝动脉介入栓塞术治疗III、IV级肝外伤的临床疗效

目的：探讨选择性肝动脉介入栓塞术治疗III、IV级肝外伤中的临床效果。方法：回顾性分析2006年1月—2016年10月收治的19例III、IV级肝外伤行肝动脉介入栓塞治疗的患者（介入组）与同期有可比性的19例III、IV级肝外伤行开腹手术治疗的患者（开腹组）临床资料。比较两组患者的主要临床指标。结果：两组均顺利完成手术操作。介入组术后血清转氨酶、肌酐水平均明显低于开腹组，且转氨酶恢复正常时间明显短于开腹组（均P<0.05）；介入组手术时间（60.74 min vs. 128.11 min）、禁食时间（34.03 h vs. 56.00 h）、住院时间（13.58 d vs. 18.37 d）、住院费用（34 860.90元vs. 54 141.47元）以及并发症发生率（10.5% vs. 57.9%）均明显低于开腹组（均P<0.05）。两组其他临床指标差异均无统计学意义（均P>0.05）。结论：选择性肝动脉介入栓塞术治疗III、IV级肝外伤是一种安全、有效的方法，建议对于血流动力学稳定或经积极抗休克、输血、输液后血流动力学稳定的III、IV级肝外伤出血可选择介入造影栓塞治疗。

Clinical efficacy of selective hepatic artery embolization for grade III or IV liver trauma

Objective: To investigate the clinical efficacy of selective hepatic artery embolization in treatment of grade III or IV liver trauma. Methods: The clinical data of 19 patients with grade III or IV liver trauma undergoing hepatic artery embolization (intervention group) from January 2006 to October 2016, and 19 comparable patients with grade III or IV liver trauma undergoing open surgery (laparotomy group) treated during the same period were retrospectively analyzed. The relevant clinical variables between the two groups of patients were compared. Results: Operations were successfully performed in both groups of patients. The postoperative serum transaminase and creatinine levels were significantly lower and the time for aminotransferase to return to normal was significantly shorter in intervention group than those in laparotomy group (all P<0.05); in intervention group compared with laparotomy group, the operative time (60.74 min vs. 128.11 min), postoperative fasting time (34.03 h vs. 56.00 h), length of hospital stay (13.58 d vs. 18.37 d) and hospitalization costs (34 860.90 yuan vs. 54 141.47 yuan) as well as incidence of complications (10.5% vs. 57.9%) were all significantly reduced (all P<0.05). No significant difference was noted in other clinical variables between the two groups (all P>0.05). Conclusion: Selective hepatic arterial embolization is a safe and effective method for grade III and IV liver trauma. For grade III or IV liver lacerations with stable hemodynamics or hemodynamic stability obtained after aggressive anti-shock therapy and blood or fluid transfusion, selection of interventional angiography is recommended.