Abstract：
The management of major liver trauma continues to evolve in trauma centers across the US with increasing use of minimally invasive techniques. Data on the outcomes of these procedures remain minimal. The objective of this study was to evaluate patient complications after perioperative hepatic angioembolization as an adjunct to management of major operative liver trauma.
A retrospective multi-institutional study was performed at 13 level 1 and level 2 trauma centers from 2012 to 2021. Adult patients with major liver trauma (grade 3 and higher) requiring operative management were enrolled. Patients were divided into 2 groups: angioembolization (AE) and no angioembolization (NO AE). Univariate and multivariate analyses were performed.
A total of 442 patients were included with AE performed in 20.4% (n = 90 of 442) of patients. The AE group was associated with higher rates of biloma formation (p = 0.0007), intra-abdominal abscess (p = 0.04), pneumonia (p = 0.006), deep vein thrombosis (p = 0.0004), acute renal failure (p = 0.004), and acute respiratory distress syndrome (p = 0.0003), and it had longer ICU and hospital length of stay (p < 0.0001). On multivariate analysis, the AE had a significantly higher amount intra-abdominal abscess formation (odds ratio 1.9, 95% CI 1.01 to 3.6, p = 0.05).
This is one of the first multicenter studies comparing AE in specifically operative high-grade liver injuries and found that patients with liver injury that undergo AE in addition to surgery have higher rates of both intra- and extra-abdominal complications. This provides important information that can guide clinical management.
A retrospective multi-institutional study was performed at 13 level 1 and level 2 trauma centers from 2012 to 2021. Adult patients with major liver trauma (grade 3 and higher) requiring operative management were enrolled. Patients were divided into 2 groups: angioembolization (AE) and no angioembolization (NO AE). Univariate and multivariate analyses were performed.
A total of 442 patients were included with AE performed in 20.4% (n = 90 of 442) of patients. The AE group was associated with higher rates of biloma formation (p = 0.0007), intra-abdominal abscess (p = 0.04), pneumonia (p = 0.006), deep vein thrombosis (p = 0.0004), acute renal failure (p = 0.004), and acute respiratory distress syndrome (p = 0.0003), and it had longer ICU and hospital length of stay (p < 0.0001). On multivariate analysis, the AE had a significantly higher amount intra-abdominal abscess formation (odds ratio 1.9, 95% CI 1.01 to 3.6, p = 0.05).
This is one of the first multicenter studies comparing AE in specifically operative high-grade liver injuries and found that patients with liver injury that undergo AE in addition to surgery have higher rates of both intra- and extra-abdominal complications. This provides important information that can guide clinical management.
摘要：
随着越来越多地使用微创技术，美国各地的创伤中心对重大肝创伤的管理不断发展。关于这些程序结果的数据仍然很少。这项研究的目的是评估围手术期肝血管栓塞术后的患者并发症，以作为主要手术肝创伤治疗的辅助手段。
从2012年到2021年，在13个1级和2级创伤中心进行了回顾性多机构研究。招募了需要手术治疗的严重肝外伤（3级及以上）的成年患者。患者分为2组：血管栓塞（AE）和无血管栓塞（NOAE）。进行单变量和多变量分析。
共有442例患者纳入了20.4%（442例中的90例）的AE。AE组与较高的胆汁瘤形成率相关（p=0.0007），腹内脓肿（p=0.04），肺炎（p=0.006），深静脉血栓形成（p=0.0004），急性肾功能衰竭（p=0.004），和急性呼吸窘迫综合征（p=0.0003），ICU和住院时间更长（p<0.0001）。在多变量分析中，AE的腹内脓肿形成量明显较高(比值比1.9,95%CI1.01~3.6,p=0.05).
这是第一个多中心研究比较AE在特定的手术高级别肝损伤，发现肝损伤的患者，除了手术外，还经历AE的腹内和腹外并发症的发生率更高。这提供了可以指导临床管理的重要信息。
从2012年到2021年，在13个1级和2级创伤中心进行了回顾性多机构研究。招募了需要手术治疗的严重肝外伤（3级及以上）的成年患者。患者分为2组：血管栓塞（AE）和无血管栓塞（NOAE）。进行单变量和多变量分析。
共有442例患者纳入了20.4%（442例中的90例）的AE。AE组与较高的胆汁瘤形成率相关（p=0.0007），腹内脓肿（p=0.04），肺炎（p=0.006），深静脉血栓形成（p=0.0004），急性肾功能衰竭（p=0.004），和急性呼吸窘迫综合征（p=0.0003），ICU和住院时间更长（p<0.0001）。在多变量分析中，AE的腹内脓肿形成量明显较高(比值比1.9,95%CI1.01~3.6,p=0.05).
这是第一个多中心研究比较AE在特定的手术高级别肝损伤，发现肝损伤的患者，除了手术外，还经历AE的腹内和腹外并发症的发生率更高。这提供了可以指导临床管理的重要信息。
