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Application And Research Of Vascular Interventional Embolization Technique In The Treatment Of Severe Hepatic Trauma

Posted on:2022-02-09Degree:MasterType:Thesis
Country:ChinaCandidate:L YeFull Text:PDF
GTID:2544306332488804Subject:Surgery
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Objective:Evaluating the role of Transcatheter arterial embolization(TAE)in the treatment of Severe liver trauma(SLT).Analyze its advantages and problems compared with traditional surgical treatment,especially its application value in the treatment of patients with unstable hemodynamics.At the same time,the indications and timing of the use of TAE were further explored to provide a basis for the better use of TAE in the treatment of severe liver trauma.Methods:A retrospective analysis of the clinical data of 22 patients with grade Ⅲ-Ⅴ SLT who underwent TAE treatment at the southeast of xiamen university affiliated hospital during the period from December 2013 to June 2020 was carried out,on the same time also have comparable with surgery treatment of the clinical data of 22 gradeⅢ-Ⅴ SLT launched were retrospectively analyzed.Taking into account the differences in treatment methods,the above two types of patients were classified into the TAE group(n=22)and the surgical group(n=22).The general clinical data and main physiological parameters in the two groups were analyzed,including preoperative and postoperative hemoglobin(Hb),red blood cells(RBC),and alanine aminotransferase(ALT),aspartate aminotransferase(AST),creatinine(Cr)levels and the time to return to normal after surgery(d),success rate(%),incidence of complications(%),operation time(h),hospitalization time(d),hospitalization expenses(yuan),etc.Study the advantages and disadvantages of the two different methods in the treatment of SLT.Results:In terms of the basic clinical data,the subjects in the surgery group and the intervention group were compared and analyzed,and the results were all P>0.05,there was no difference,lacking of statistical value.The comparison results of the three indexes of Hb,RBC and Cr at the time of no intervention and 1 day after intervention were all P>0.05,that is,there was no obvious difference,lacking of statistical value.In terms of ALT and AST without intervention,compared with the operation group,the intervention group showed no significant difference in these two indicators,and lacked statistical value(P>0.05).ALT and AST of the intervention group at 1,3 and 7 days after intervention were significantly different from those of the operation group at the same time,which had statistical value(P<0.05),and the indexes of the intervention group were lower than those of the operation group.The time for ALT and AST return to normal in the intervention group was shorter than operation group,and the difference was statistically significant(P<0.05).The duration of operation,patients in the intervention group were shorter than those in the operation group,and the difference was statistically significant(P<0.05).The length of hospital stay,patients in the intervention group were shorter than those in the surgery group,and the difference showed statistical value.The patients in the intervention group were significantly less than those in the operation group in the hospitalization cost,compared with the surgery group,and the difference showed statistical value(P<0.05).The success rate of interventional group was 95.6%(21/22).Only 1 patient had recurred bleeding after TAE treatment,but the bleeding stopped after conservative treatments(hemostasis and fluid supplementation).Among them,8 patients with unstable hemodynamics in the interventional group recovered quickly after TAE treatment,and the therapeutic effect was significant.The success rate of surgical group was 90.9%(20/22),and 2 patients died on stage due to severe blood loss.The complication rate in the interventional group was 31.8%(7/22),and in the surgical group was 55%(11/20).All related complications were cured with the aid of minimally invasive surgical(MIS)techniques such as puncture catheterization and drainage under the guidance of color Doppler ultrasound and endoscopic nasal bile duct drainage(ENBD).Success rate of treatment,the intervention group showed obvious higher than the operation group,and the incidence of complications was also obvious lower in the intervention group.Conclusion:TAE as a type of minimally invasive interventional embolization technique,is relatively simple and easy to operate and effective in hemostasis compared with traditional surgical treatment in the hemostatic treatment of SLT,it has the advantages of small second blow to patients.As a supplement to conservative treatment and surgical treatment of severe liver injury,it has an important position and further improves the success rate of treatment of SLT and reduces the incidence of complications.Even for SLT Ⅲ-Ⅴ patients with hemodynamic instability,can also be effective treatment.Even there is a certain incidence of complications after TAE,the incidence of related complications is within the acceptable range.After comprehensive treatment with MIS techniques such as UG-TPPCD and ENBD,etc.The related complications can be effectively cured.
Keywords/Search Tags:Transcatheter arterial embolization, Severe liver trauma, Minimally invasive surgical technique
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