鈍的外傷性腹部実質臓器損傷および外傷性脳損傷を伴う症例に対する塞栓術と開腹手術の比較成績

This retrospective observational study compared the outcomes of transcatheter arterial embolization (TAE) versus open surgery in patients with blunt abdominal solid organ injury (liver, spleen, or kidney; abdominal Abbreviated Injury Scale [AIS] ≥ 3) with traumatic brain injury (TBI) (head AIS ≥ 3), using data from the Japan Trauma Data Bank (2004-2019). Patient characteristics were adjusted using propensity score matching. The primary endpoint was in-hospital mortality; secondary endpoints included 48-h mortality, transfusion requirements, and complications. After matching, 135 patients per group were analyzed. In-hospital mortality was significantly lower in the TAE group (25/135 [18.5%] vs. 42/135 [31.1%], adjusted odds ratio [AOR] 0.247, 95% confidence interval 0.101-0.605, p = 0.002). TAE also showed lower 48-h mortality (10/135 [7.4%] vs. 22/135 [16.3%], AOR 0.306, p = 0.008) and transfusion rates. Complication rates were similar. Subgroup analysis showed that TAE was associated with lower mortality in non-shock (AOR 0.392, p = 0.032), elderly (AOR 0.293, p = 0.044), and focal TBI patients (AOR 0.301, p = 0.004) but not in patients with diffuse TBI. TAE may be a feasible treatment option for selected patients with blunt abdominal solid organ injury complicated by TBI, particularly in hemodynamically stable, elderly, and focal TBI patients. These findings require prospective validation.