腹腔镜手术联合肝动脉栓塞治疗外伤性肝破裂患者临床疗效及影响预后因素分析

doi:10.3969/j.issn.1672-5069.2019.03.030

摘要/Abstract

摘要： 目的探讨腹腔镜手术联合选择性肝动脉栓塞（TAE）治疗外伤性肝破裂患者的临床疗效及术后感染发生的影响因素。方法 2015年5月~2018年6月我院收治的83例外伤性肝破裂患者,41例接受腹腔镜手术,42例接受腹腔镜手术联合TAE治疗。采用二元Logistic回归分析影响外伤性肝破裂患者术后感染发生的相关因素。结果在术后1 w,联合组患者有效止血率为90.5%,显著高于腹腔镜手术组患者的79.5%,差异有统计学意义（x²=3.938,P<0.05）;联合组发生术后感染3例（7.1%）,腹腔镜手术组发生感染11例（26.8%）,两组差异有统计学意义（x²=5.734,P=0.017）;单因素和多因素分析显示,肝损伤程度、术中出血量、手术时间、外周血白细胞计数、糖尿病和手术方法为外伤性肝破裂患者术后感染发生的危险因素（P<0.05）。结论采用腹腔镜手术联合TAE治疗肝破裂出血患者止血有效率较高,针对合适的患者采用联合手术方案,能提高治疗效果。

关键词: 肝破裂, 肝动脉栓塞, 腹腔镜手术, 感染

Abstract: Objectiv To investigate the clinical efficacy of laparoscopic surgery combined with transhepatic artery embolization（TAE） for the treatment of patients with traumatic liver rupture. Methods 83 patients with traumatic liver rupture were admitted to our hospital between May 2015 and June 2018,and 41 received laparoscopic surgery,and 42 received laparoscopic surgery combined with TAE. Logistic regression analysis was applied to analyze the risk factors affecting postoperative infection in patients with traumatic liver rupture. Results At the end of one week post-operation,the hemostatic rate in combination group was 90.5%,significantly higher than 79.5% in laparoscopic surgery group （x²=3.938,P<0.05）;the incidence of postoperative abdominal infection occurred in 3 cases （7.1%） in the combined group,significantly lower than in 11 cases （26.8%） in the laparoscopic group （x²=5.734,P<0.05）;univariate and multivariate analysis showed that the degree of liver injury,intraoperative blood loss,operation time,white blood cell counts,diabetes mellitus and surgery were the risk factors affecting post-operative infection in patients with traumatic liver rupture （P<0.05）. Conclusion Laparoscopic surgery combined with TAE is effective in hemostasis of liver rupture,and it is an appropriate alternative for patients with traumatic liver rupture in emergency.

Key words: Traumatic liver rupture, Transhepatic artery embolization, Laparoscopic surgery, Infection

田宋君, 李伟学, 李中明, 昌红斌, 詹争明, 江铃. 腹腔镜手术联合肝动脉栓塞治疗外伤性肝破裂患者临床疗效及影响预后因素分析[J]. 实用肝脏病杂志, 2019, 22(3): 429-432.

Tian Songjun, Li Weixue, Li Zhongming. Clinical efficacy of laparoscopic surgery combined with transhepatic artery embolization for the treatment of patients with traumatic liver rupture[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2019, 22(3): 429-432.

参考文献

[1] 王松平,袁中旭,刘书先,等. 84例外伤性肝破裂诊疗经验分析. 实用肝脏病杂志,2016,19(3):331-334.
[2] Chiba F,Inokuchi G,Makino Y,et al.Postmortem angiography revealing traumatic rupture of the intracranial internal carotid artery. Int J Legal Med,2017,132(1):1-4.
[3] Zheng Y,Jiang Q,Lyu YE,et al.Role of laparoscopy as a minimally invasive procedure in treatment of ruptured uterine scar during second-trimester induction of abortion. J Obstet Gynaecol Res,2016,42(4):464-466.
[4] Thapar PM,Philip R,Masurkar VG,et al.Laparoscopic splenectomy for spontaneous rupture of the spleen. J Minim Access Surg,2016,12(1):75-78.
[5] Fan WZ,Zhang YQ,Yao W,et al.Is emergency transcatheter hepatic arterial embolization suitable for spontaneously ruptured hepatocellular carcinoma in Child-Pugh C cirrhosis J Vasc Interv Radiol,2018,29(3):404-412.
[6] Moore EE,Cogbill TH,Jurkovich GJ,et al.Organ injury scaling:spleen and liver (1994 revision). J Trauma,1995,38(3):323-324.
[7] Vijayakumar V,Mushahida S,Prasanthkumar MS,et al.An unusual cause for concealed hemorrhagic shock in the second trimester of pregnancy resulting in fetal demise. J Anaesthesiol Clin Pharmacol,2016,32(1):127-128.
[8] Anyanwu CT,Reynal SD.Delayed splenic rupture resulting in massive intraperitoneal hemorrhage post ambulatory-related injury. Cureus,2018,10(2):e2160.
[9] Namazov A,Grin L,Volodarsky M,et al.Laparoscopic management of uterine rupture after early second-trimester medical abortion in a patient with a prior cesarean section. J Minim Invasive Gynecol,2016,23(6):862-862.
[10] Warren YE,Kirks RC,Thurman JB,et al.Laparoscopic microwave ablation for the management of hemorrhage from ruptured hepatocellular carcinoma. Hippokratia,2016,20(2):169-171.
[11] Feng W,Yue D,Zaiming L,et al.Iatrogenic hemobilia: imaging features and management with transcatheter arterial embolization in 30 patients. Diagn Interv Radiol,2016,22(4):371-377.
[12] Xu L,Wang S,Zhuang L,et al.Decoction alleviated postembolization syndrome following transcatheter arterial chemoembolization for hepatocellular carcinoma:a randomized,double-blind,placebo-controlled trial. Integr Cancer Ther,2016,15(3):349-357.
[13] Schietroma M,Pessia B,Colozzi S,et al. Does bacterial translocation influence the postoperative infections in splenectomized patients after abdominal trauma Surgeon,2018,16(2):94-100.
[14] Koyama T,Skattum J,Engelsen P,et al.Surgical intervention for paediatric liver injuries is almost history-a 12-year cohort from a major Scandinavian trauma centre. Scand J Trauma Resusc Emerg Med,2016,24(1):139-143.
[15] Ayx I,Müllerwille R,Wohlgemuth WA,et al.Treatment of acute hemoptysis by bronchial artery embolization with the liquid embolic agent ethylene vinyl alcohol copolymer. J Vasc Interv Radiol,2017,28(6):825-831.
[16] Zeng JC,Xiang WY,Lin DZ,et al.Elevated HMGB1-related interleukin-6 is associated with dynamic responses of monocytes in patients with active pulmonary tuberculosis. Int J Clin Exp Pathol,2015,8(2):1341-1353.
[17] Safavi A,Skarsgard ED,Rhee P,et al.Trauma center variation in the management of pediatric patients with blunt abdominal solid organ injury:a national trauma data bank analysis. J Pediatr Surg,2016,51(3):499-502.
[18] Garcíacompeán D,Gonzálezgonzález JA,Lavallegonzález FJ,et al.Current concepts in diabetes mellitus and chronic liver disease:clinical outcomes,hepatitis C virus association,and therapy. Dig Dis Sci,2016,61(2):371-380.
[19] Seko Y,Sumida Y,Tanaka S,et al.Insulin resistance increases the risk of incident type 2 diabetes mellitus in patients with non-alcoholic fatty liver disease. Hepatol Res,2017,48(3):42-51.
[20] Pericleous M,Caplin ME,Tsochatzis E,et al.Hepatic artery embolization in advanced neuroendocrine tumors:Efficacy and long-term outcomes. Asia Pac J Clin Oncol,2016,12(1):61-69.