创伤性肝、脾、肾破裂出血的介入治疗

目的探讨介入栓塞治疗应用于创伤性肝、脾、肾破裂出血患者的临床疗效。方法回顾性分析莆田市第一医院介入血管外科2016年2月—2018年2月介入栓塞治疗腹腔实质性脏器破裂出血患者共101例,患者术前均经腹部CT、彩超确诊为腹腔脏器挫裂伤出血。其中肝破裂组32例,男性20例,女性12例;年龄5~82岁,平均35.9岁;道路交通伤25例,坠落或摔伤3例,暴力性创伤2例和刀刺伤2例。脾破裂组45例,男性36例,女性9例;年龄16~85岁,平均45.6岁;道路交通伤20例,坠落或摔伤18例和暴力性创伤7例。肾破裂组24例,男性21例,女性3例;年龄18~71岁,平均40.6岁;道路交通伤16例,坠落或摔伤5例和暴力性创伤3例。介入时机为经内科非手术治疗无效,生命体征相对稳定,不能或不愿接受外科手术治疗。记录所有出血患者的术中造影情况、止血成功率和术后手术相关并发症情况。结果(1)肝破裂组:30例造影发现出血灶,余2例发现可疑出血灶。30例(93.8%)术后止血成功;术后出现肝区疼痛15例、发热5例、肝功能损害10例。(2)脾破裂组:41例造影发现出血灶,余4例造影发现可疑出血灶。42例(93.3%)术后止血成功;术后出现脾区疼痛22例、发热11例。(3)肾破裂组:24例造影均发现出血灶。23例(95.8%)术后止血成功,1例术后1 d再发肾出血,再次行栓塞治疗后好转;术后出现患侧肾区酸胀疼痛12例,发热4例。结论介入栓塞治疗应用于创伤性腹腔脏器破裂出血患者安全、有效,值得临床推广应用。

Interventional therapy of traumatic rupture of liver,spleen and kidney

Objective To explore the clinical efficacy of interventional embolotherapy in the treatment of traumatic rupture of liver,spleen and kidney.Methods Totally 101 patients with rupture and hemorrhage of abdominal substantive organs who received interventional embolotherapy in the First Hospital of Putian City were collected retrospectively.All patients were diagnosed with abdominal organ contusion and bleeding by abdominal CT and color Doppler ultrasound.There were 32 cases of liver rupture,including 20 males and 12 females;their age ranged from 5 to 82 years,with an average of 35.9 years;there were 25 cases of road traffic injuries,3 cases of falls,2 cases of violent trauma,and 2 cases of knife stab.There were 45 cases of spleen rupture,including 36 males and 9 females;their age ranged from 16 to 85 years,with an average of 45.6 years;there were 20 cases of road traffic injuries,18 cases of falls,and 7 cases of violent trauma.There were 24 cases of kidney rupture,including 21 males and 3 females;their age ranged from 18 to 71 years,with an average of 40.6 years;there were 16 cases of road traffic injuries,5 cases of falls,and 3 cases of violent trauma.The intervention was conducted when non-surgical treatment was ineffective,vital signs were relatively stable,and surgical treatment was not possible or unwilling.Situations of intraoperative angiography,success rate of hemostasis and postoperative operative complications were recorded in all patients with bleeding.Results(1)Hepatic rupture group:Thirty patients were found with hemorrhagic lesions by angiography,and the remaining two patients were found with suspicious hemorrhagic lesions.Thirty patients(93.8%)had successful hemostasis after operation.There were 15 cases of hepatic pain,5 cases of fever and 10 cases of liver damage after surgery.(2)Splenic rupture group:Forty-one patients were found with hemorrhagic lesions by angiography,and the remaining four patients were found with suspicious hemorrhagic lesions.Forty-two patients(93.3%)had successful hemostasis after operation.There were 22 cases of spleen pain and 11 cases of fever after surgery.(3)Renal rupture group:All twenty-four patients were found with hemorrhagic lesions by angiography.Twenty-three patients(95.8%)had successful hemostasis after operation.One patient had recurrence of renal hemorrhage at 1 day after surgery,and improved after embolization again.There were 12 cases renal soreness of in the trouble side,and 4 cases of fever after surgery.Conclusion Interventional therapy is safe and effective in treatment of traumatic abdominal organ rupture,and worthy of clinical application.