选择性肝动脉介入栓塞术治疗Ⅲ、Ⅳ级肝外伤的临床疗效

发布时间：2018-02-01 00:13

本文关键词： 肝/损伤创伤和损伤栓塞治疗性　出处：《中国普通外科杂志》2017年07期 　论文类型：期刊论文

【摘要】：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P0.05);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P0.05)。两组其他临床指标差异均无统计学意义(均P0.05)。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。
[Abstract]:Objective: To investigate the effect of selective hepatic artery embolization for the treatment of clinical effect, grade of liver trauma. Methods: a retrospective analysis of 19 cases of January 2006 - October 2016, trauma patients underwent hepatic artery interventional embolization for the treatment of grade IV liver (the intervention group) can be compared with 19 cases of III and IV in the same period, liver trauma treated by laparotomy (laparotomy group) in patients with clinical data were compared between the two groups. The main clinical indicators. Results: the two groups were operated successfully. The intervention group postoperative serum transaminase, creatinine levels were significantly lower than the laparotomy group, and transaminase recovery time was shorter than the laparotomy group (P0.05); intervention operation time (60.74 min vs.128.11 min), fasting time (34.03 h vs.56.00 h), hospitalization time (13.58 D vs.18.37 d), hospitalization expenses (34860.90 yuan vs.54 141.47 yuan) and the incidence of complications (10.5%vs.57.9%) were significantly lower than those in the open Group (P0.05). Two groups of other clinical indicators showed no significant difference (P0.05). Conclusion: selective hepatic artery embolization in treatment of hepatic trauma of grade III, is a safe, effective method, suggestions for hemodynamic stability through blood transfusion or active anti shock, and after infusion of hemodynamic stability III IV, hepatic trauma hemorrhage interventional embolization treatment of choice.

【作者单位】：福建医科大学福总临床医学院/中国人民解放军南京军区福州总医院肝胆外科;
【基金】：中国人民解放军南京军区医学重大专项(14ZX22) 福建省科学技术厅科技计划基金资助项目(2015Y0026)
【分类号】：R657.3
【正文快照】： 肝脏是腹部最大的实质性脏器,因其组织脆弱,面积较大,在腹部外伤中发生率位于第2位,肝脏血管丰富,且多为多发伤,损伤后病死率高。肝外伤的治疗标准不统一,以往多数认为肝外伤出血一确诊应立即手术探查,研究[1]表明肝外伤手术治疗并发症高达38%,病死率达8%~14%,且肝外伤行手术

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