创伤与治疗杂志

Transarterial Embolization Affects Recovery in Nonoperative Management of Severe Blunt Hepatic Injuries: A Retrospective Study

Abstract

Kazuhiko Sekine, Shokei Matsumoto, Tomohiro Funabiki, Yoko Sugawara, Jun-Ichi Sasaki and Mitsuhide Kitano

Introduction: Transarterial embolization (TAE) has been used as an essential technique in the nonoperative management (NOM) of severe blunt hepatic injuries (BHI) but has a possible risk of tissue ischemia and necrosis, which may affect hepatic recovery. The injured liver tissue gets encapsulated and absorbed by intact liver tissue; therefore, the healing process requires the formation of a wall surrounding the injured tissue. In this study, we determined the impact of TAE on the hepatic healing process.
Patients and methods: We reviewed hemodynamically stable patients (n=35; males, 23; females, 12; mean age, 32 years), admitted to our hospitals over a 10-year period, who underwent NOM of severe BHI (American Association for the Surgery of Trauma Organ Injury Scale, grades IV and V). Data collected included demographic information, serial CT findings, severity of hepatic injuries showing lacerations (Couinaud's liver segment classification), TAE performed for active hepatic bleeding, and the amount of hemoperitoneum. Extrahepatic factors were evaluated using the Abbreviated Injury Scale for injuries to the head, face, thorax, and extremities. Time taken by injured segments to encapsulate was individually obtained from serial CTs. Cox regression and Kaplan-Meier analyses were used to identify risk factors associated with delayed healing among the hepatic and extrahepatic factors mentioned above.
Results: Risk factors were independently and significantly associated with TAE (odds ratio, 2.45; 95% confidence interval, 1.01-5.92; p=0.047). Multivariate analysis indicated that patients who underwent TAE took 2.45-times longer time to attain liver encapsulation than those who did not undergo TAE and that extrahepatic factors did not correlate with the time to encapsulation.
Conclusion: TAE for active liver hemorrhage resulted in a delayed recovery from BHI, regardless of extrahepatic factors.