Angiographic Embolotherapy is An Effective Treatment for Blunt Splenic Injuries with Active Hemorrhage or Transient Response to Fluid Resuscitation

動脈栓塞術有效治療流血不止或對輸液有短暫反應

黃成之(Chen-Chih Huang) ； 王俐人(Li-Jen Wang) ； 黃耀祥(Yon-Cheong Wong) ； 吳政賢(Cheng-Hsien Wu) ； 劉原彰(Yuan-Chang Liu) ； 傅真如(Chen-Ju Fu,) ； 陳煥武(Huan-Wu Chen) ； 方禎鋒(Jen-Feng Fang)

《中華放射線醫學雜誌》 33卷1期 (2008/03) Pp. 9-15

摘要

脾臟鈍傷的病人，若在電腦斷層檢查中發現有急性出血，或是對輸液治療僅有暫時效果者，可施以導管動脈栓塞術加以治療。本回溯性研究的目的在決定不同方式的栓塞治療之有效性，併發症，及病人最終的療效。
從2001年1月到2004年12月，總共回顧了30位接受脾臟栓塞治療成年病人的病歷。其中一位多重外傷的病人，在血管栓塞治療過程中死亡，被排除在此研究之外。剩餘29位病人中，9位病人(31.0%)接受選擇性脾動脈分枝的栓塞，17位病人(58.6%)接受脾動脈主幹栓塞，3位病人(10.4%)同時接受脾動脈主幹及其分枝的栓塞。有2位病人(6.9%)在栓塞術後仍發生持續的血紅素下降。2位病人(6.9%)在栓塞術後有產生脾臟膿瘍。29位病人無一死亡於脾臟相關的出血。以接受選擇性脾動脈分枝栓塞的病人和接受脾動脈主幹栓塞的病人做比較，前者發生栓塞後併發症的odds ratio為2.00 (95% CI: 0.11, 36.31)。以接受選擇性脾動脈分枝栓塞的病人和非接受選擇性脾動脈分枝栓塞的病人做比較，前者發生栓塞後併發症的odds ratio為2.38 (95% CI: 0.13, 42.83)。
本研究之結論是，不同方式的栓塞治療與其有效性，併發症，及病人最終的療效，並無統計學上有意義的相關性，然而，接受選擇性脾動脈分枝栓塞的病人比接受脾動脈主幹栓塞的病人似乎有較高的風險產生併發症。

並列摘要

Patients of blunt splenic injuries who had CT findings of active hemorrhage or transient response to fluid resuscitation were referred for angiographic embolotherapy. The purpose of this retrospective study was to determine the effectiveness, complications, and final outcome of different types of embolotherapy.
The charts of 30 consecutive adult patients who received spleen embolotherapy from January 2001 to December 2004 were reviewed. One patient of multiple trauma died during embolotherapy was excluded. Of the remaining 29 patients, 9 (31.0%) underwent superselective branch-artery alone embolotherapy, 17 (58.6%) main-artery alone embolotherapy, 3 (10.4%) both branch- and main-artery embolotherapy. A continuous drop of hemoglobin occurred in 2 (6.9%) patients. Splenic abscess developed in 2 (6.9%) patients. None of the 29 patients died of spleen-related hemorrhage. For patients accepted branch-artery alone embolotherapy, the odds ratios of having a post-embolotherapy event were 2.00 (95% CI: 0.11, 36.31), when compared with patients accepted main-artery alone embolotherapy. The ratios were all 2.38 (95% CI: 0.13, 42.83) for patients with branch-artery alone embolotherapy, when compared with patients who were not treated with branch-artery embolotherapy alone.
In conclusion, the association between risk factors (effectiveness, complications, outcomes) and types of embolotherapy had no statistical significance, however, it seemed that people who accepted branch-artery alone embolotherapy had a higher risk of complications than people accepted main-artery embolotherapy.