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.
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。