稳定患有突发性肝损伤的患者的观察第一与血管栓塞第一方法:WTA多中心研究
Peter D Nguyen1, Jeffry Nahmias, Negaar Aryan
1From the Division of Division of Trauma, Burns and Surgical Critical Care, Department of Surgery (P.D.N., J.N., N.A., A.G.), University of California, Irvine, Orange, California; Section of Surgical Sciences (J.M.S.), Vanderbilt University Medical Center, Nashville, TN; Department of Surgery, University of Colorado, Aurora, Colorado (M.C., H.C., R.M., S.U., C.C.B., C.V.); Department of Surgery (S.B., R.C.D.), UCSF-Fresno, Fresno, California; Division of Trauma and Acute Care Surgery (M.C.S.), Mount Carmel East; Trauma, Critical Care and Acute Care Surgery (A.L.), Grant Medical Center, Columbus, Ohio; Department of Surgery (M.S.F.), Lehigh Valley Health Network, Allentown, Pennsylvania; Departments of Emergency Medicine and Surgery, Program in Trauma (D.M.S.), R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland; Graduate Medical Education (M.S.T., H.M.G.V.), Methodist Dallas Medical Center, Dallas, Texas; Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery (C.J.M., T.J.M.), Spartanburg Regional Medical Center, Spartanburg, South Carolina; Department of Surgery (C.G.B.), University of Calgary, Calgary, Alberta, Canada; Division of Acute Care Surgery (K.M., G.M.), Loma Linda University Health, Loma Linda, California; Department of Surgery (D.J.H., H.A.), University of Maryland School of Medicine, Baltimore, Maryland; Department of Trauma and Acute Care Surgery (T.J.S., J.R.), UCHealth Memorial Hospital, Colorado Springs, Colorado; Department of General Surgery (M.B.), Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Division of Trauma, Acute Care Surgery and Surgical Critical Care (N.K., M.C.), Banner-University Medical Center Phoenix, Phoenix, Arizona; Division of Trauma and Critical Care, Department of Surgery (N.K.D., E.J.L.), Cedars-Sinai Medical Center, Los Angeles, California; Department of Surgery (T.E., J.W.), Cooper University Hospital, Camden, New Jersey; Department of Surgery and Perioperative Care (T.C.P.C., V.E.), Dell Medical School, University of Texas at Austin, Austin, Texas; Division of Trauma Acute Care Surgery, Department of Surgery (K.P., K.C.), Banner Thunderbird Medical Center, Glendale, Arizona; Division of Trauma and Surgical Critical Care, Department of Surgery (S.B.), Hackensack University Medical Center, Hackensack, New Jersey; Division of Trauma and Surgical Critical Care, Department of Surgery (F.S.E.), Rutgers New Jersey Medical School, Newark, New Jersey; Department of Trauma and Acute Care Surgery (W.D., C.P.), Medical Center of the Rockies, Loveland, Colorado; University of Wisconsin-Madison School of Medicine and Public Health (N.L.W.), Madison, Wisconsin; Department of Trauma (J.M.H., K.L.), Ascension Via Christi Saint Francis, Wichita, Kansas; Department of Surgery (G.S.), Miami Valley Hospital, Wright State University, Dayton, Ohio; Department of Surgery (K.S.), Prisma Health-Upstate, Greenville, South Carolina; and Department of Surgery (L.A.H.), Boulder Community Hospital, Boulder, Colorado.
随着对比外流,对粗肝损伤的观察初步管理显示,与血管栓塞相比,与肝脏相关的并发症风险相似. 这项多中心研究建议重新评估这些患者的常规血管栓塞.
科学领域:
- 创伤外科 手术 创伤外科
- 干预性放射学 干预性放射学
- 腹部成像 腹部成像 腹部成像
背景情况:
- 之前的研究观察与血管栓塞 (AE) 对于的肝损伤 (BLT) 与对比扩散 (CE) 有不一致的发现.
- 单中心和回顾性设计的局限性阻碍了最终的结论.
- 多中心方法对于稳健比较管理策略至关重要.
研究的目的:
- 为了将BLT与CE的观察优先与AE优先管理进行比较.
- 假设观察导致肝脏相关并发症 (LRCs) 的减少.
- 在BLT患者中识别与LRC相关的风险因素.
主要方法:
- 一个多中心,前性观察性研究 (2019-2021) 后期分析,涉及23个中心.
- 包括在8小时内观察或AE管理的BLT + CE成人患者.
- 主要结局:LRCs (周肝液,胆汁泄漏/胆瘤,伪动脉瘤,缩,).
- 多变量逻辑回归用于风险因素分析.
主要成果:
- 71名患者 (55.5%) 首先接受观察,57名 (45.5%) 首先接受AE.
- 在AE组中,高度伤害较多 (AST IV级:51.0%对22.0%).
- 在AE队列中,住院LRC (36.8%对12.7%),ED再呈现 (25.0%对10.0%) 和LRC再入院 (12.3%对1.4%) 的比例较高.
- 死亡率是相似的 (5.7%对5.3%).
- 调整后的分析显示,观察第一和AE第一方法之间的LRC风险相似 (OR1.949;p=0.219).
结论:
- 与AE-first相比,BLT与CE的观察优先管理与类似的调整后LRC风险和死亡率有关.
- 对于所有患有CE的突发性肝损伤患者来说,常规AE可能不需要.
- 需要进一步的前性随机试验来证实这些发现.
更多相关视频
09:49Dual-phase Cone-beam Computed Tomography to See, Reach, and Treat Hepatocellular Carcinoma during Drug-eluting Beads Transarterial Chemo-embolization
Published on: December 2, 2013
13:57Laparoscopic Anatomical Liver Segment VII Resection with Liver Parenchymal Transection Following a Priority Approach
Published on: May 23, 2025
相关概念视频
Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
Flail Chest-II
Assessment:
1. Clinical Evaluation:
History:
