Comparison Of Selective Hepatic Artery Embolization And Surgical Treatment In Stage Ⅲ And Ⅳ Hepatic Trauma

Objective:To explore the effect of selective hepatic artery embolization and surgical treatment in stage III and IV liver trauma,and the effect on postoperative complications and prognosis.Method:Retrospective analysis of January 2006-October 2016 Fuzhou General Hospital treatment of 19 cases of grade III,IV hepatic trauma in patients undergoing hepatic artery embolization,and the use of the same injury level,similar age(the largest difference of 13 years old),The time of admission(the longest difference of 1 year and 5 months)matching method to select the same period III,IV grade liver injury surgery in patients with open surgery clinical data.There were 19 patients with hepatic artery embolization(group A),13 males and 6 females,aged from 15 to 68 years(mean age 35.3 years).Surgical treatment group(B group)19 cases,including 15 males and 4 females;aged 15 to 55 years,mean age 37.0 years old.The operation time,intraoperative blood transfusion cases,red blood cells and hemoglobin before and after surgery,serum ALT and AST before and after surgery,serum creatinine before and after surgery,postoperative liver function recovery time,postoperative fasting time,length of hospital stay,hospital costs,postoperative complications,was compared and analyzed between the two groups.Results:19 cases of stage Ⅲ,Ⅳ grade liver injury early choice of hepatic artery interventional embolization,the success rate of surgery(19/19)was 100%,the success rate of treatment(18/19)was 94.7%,the complication rate was(2/19)10.5%,and the mortality rate(0/19)was 0%.Compared with the open surgery group.The serum ALT and AST were statistically significant(P <0.05),and the difference of ALT recovery time between the two groups was statistically significant(P <0.05),the statistics are(6.06 ± 0.97)days,(10.95 ± 2.25)days(t =-8.714,P <0.05),the recovery of liver function in the intervention group was fast.There were significant differences between the two groups in operation time,postoperative fasting time,hospital stay and hospitalization cost(P <0.05),the operation time are(60.74 ± 9.52)min,(128.11 ± 24.10)min(t =-11.331,P <0.05),the fasting time is(34.03 ± 8.27)h,(56.00 ± 16.20)h(t =-5.120,P <0.05),the number of hospital days were(13.58 ± 4.48)days,(18.37 ± 6.68)days(t =-2.597,P <0.05),the cost of hospitalization is(34860.90 ± 10518.41)yuan,(54141.47 ± 16894.01)yuan(t =-4.223,P <0.05),in the intervention group,the operation time was shorter than that of the laparotomy group,and the diet was resumed at the early stage,the hospital stay was short,the hospitalization cost was low.The complication rate in grouphepatic interventional embolization(2/19,10.5%)were significantly shorter than that in group surgical treatment(11/19,54.89%)(P <0.05).Conclusion:Selective hepatic arterial embolization for the treatment of grade Ⅲ and Ⅳ hepatic trauma is a viable,safe and effective method.Compared with laparotomy,the operation time is short,the patient is less injured,less pain,early recovery of liver function,hospitalization time Short,low cost of hospitalization,less complications and other advantages.Recommendations for hemodynamic stability or After active anti-shock,blood transfusion,infusion hemodynamic stabilityⅢ,Ⅳ level of liver injury bleeding can be preferred interventional angiography embolization,he can early diagnosis,clear responsibility for blood vessels and timely intervention and treatment.