关键词: 肝介入栓塞术, 开腹手术, Ⅲ、Ⅳ级肝外伤, 肝功能

Abstract: Objective To study on the recovery of liver function in patients with grades III and IV liver trauma after interventional embolization or open abdominal surgical therapies.Methods 82 patients with grades III and IV liver trauma from May 2017 to November 2020 were included. They were divided into an observation group (40 cases, treated with hepatic interventional embolization) and a control group (42 cases, treated with laparotomy) according to different treatments that the patients had received. The postoperative liver function and complications were recorded in all patients, and the postoperative recovery was compared between the two groups.Results No death in the observation group but 2 cases of death in the control group happened after the treatments. The operation time and postoperative hospital stay of the observation group were significantly shorter than those of the control group (69.3±13.1 min vs 114.7±20.2 min, and 7.6±1.3 d vs 9.2±1.8 d, respectively)(t=12.010, 4.595; P<0.05). The amount of bleeding in the observation group was significantly less than that of the control group (165.0±45.8 mL vs 214.9±70.3 mL, t=3.788, P<0.05). The levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TBil) and gamma glutamyl transferase (GGT) in patients of the observation group were significantly lower than those in the control group at one day (237.5±80.2 U/L, 298.7±98.5 U/L, 94.2±27.2 μmol/L and 103.2±21.4 U/L vs 280.2±69.6 U/L, 367.7±86.1 U/L, 117.3±20.2 μmol/L and 118.9±26.4 U/L; t=2.543, 3.336, 4.312 and 2.922, respectively; P<0.05), 3 days (104.4±54.3 U/L, 175.5±80.3U/L, 64.4±19.5 μmol/L and 90.6±16.3 U/L, vs 173.5±70.3 U/L, 245.8±98.5 U/L, 82.2±15.3 μmol/L and 107.7±26.3 U/L, t=4.920, 3.499, 4.542, and 3.495, respectively; P<0.05) and 5 days (90.6±36.5 U/L, 105.4±96.5 U/L, 57.9±17.6 μmol/L and 80.5±13.7 U/L, vs 138.2±33.6 U/L, 182.3±63.2 U/L, 75.7±20.1 μmol/L and 95.1±18.8 U/L, t=6.068, 4.216, 4.214, 3.969, respectively; P<0.05) after operation. There were significant differences in the incidence of postoperative abdominal bleeding (1 case vs 7 cases) and liver abscess (0 case vs 5 cases) between the observation group and the control group (χ²=5.000 and 5.333, respectively; P<0.05).Conclusion The transcatheter hepatic embolization therapy is effective and safe for the treatment of grades III and IV liver trauma. The early recovery of liver function after embolization therapy is better than that of open abdominal surgery.

Key words: Hepatic interventional embolization, Laparotomy, Grades III and IV hepatic trauma, Hepatic function