介入治疗头颈颌面部创伤难治性出血的疗效及安全性

Efficacy and safety of interventional treatment for refractory bleeding caused by head，neck，and maxillofacial trauma

摘要

目的 探讨经导管动脉栓塞术（transcatheter arterial embolization，TAE）头颈颌面部创伤难治性出血的疗效和安全性。 方法 回顾性分析河南省直第三人民医院和郑州大学第一附属医院采用TAE治疗26例头颈颌面部创伤难治性出血患者的临床资料，男性16例，女性10例，平均年龄（57.96±15.52）岁。所有患者均因药物、填塞止血等措施治疗效果差、反复出血转而行TAE治疗。分析患者的临床资料、手术成功率、有效止血率、30 d临床成功率及术后并发症，并进行3~6个月随访。 结果 TAE手术成功率100%，所有患者的出血症状得到有效控制，有效止血率100%，术前血红蛋白（96.21±12.42） g/L，术后3 d升至（111.38±7.70） g/L（P<0.001）。术后3例患者出现头颈颌面部轻微肿胀、疼痛或皮肤颜色改变，对症处理后有效缓解或消失，2例患者因颅脑创伤严重、脑水肿导致死亡，所有患者均未出现脑梗死等严重并发症。出院后随访3~6个月，均无再出血。 结论 TAE治疗头颈颌面部创伤所致的难治性出血疗效确切，安全性良好，具有较高的临床推广价值。

Abstract

Objective To investigate the efficacy and safety of transcatheter arterial embolization （TAE） in the treatment of refractory bleeding caused by head，neck，and maxillofacial trauma. Methods The clinical data of 26 patients with refractory bleeding caused by head，neck and maxillofacial trauma who were treated with TAE in The First Affiliated Hospital of Zhengzhou University and The Third People’s Hospital of Henan Province were analyzed retrospectively，including 16 males and 10 females，with an average age of 57.96±15.52 years. All patients were treated with TAE because of the poor effect of medication，packing，and other measures and repeated bleeding. The clinical data，operation success rate，effective hemostasis rate，30-day clinical success rate，and postoperative complications were analyzed. The patients were followed up for 3 to 6 months. Results The operation success rate of TAE was 100%. The bleeding symptoms of all patients were effectively controlled，and the effective hemostasis rate was 100%. The hemoglobin level was increased from （96.21±12.42） g/L before operation to （111.38±7.70） g/L at 3 days after operation（P<0.001）. After operation，3 patients had slight swelling，pain，or skin color changes in the head，neck，and maxillofacial region，which were effectively relieved or disappeared after symptomatic treatment；2 patients died of severe traumatic brain injury and cerebral edema. No serious complications such as cerebral infarction occurred in any patients. There was no rebleeding in any patients within 3 to 6 months of post-discharge follow-up. Conclusion TAE has definite curative effect and good safety for refractory bleeding caused by head，neck，and maxillofacial trauma，and has high clinical application value.

关键词

颌面损伤 / 出血 / 血管造影术，数字减影 / 难治性出血 / 经导管动脉栓塞术

Key words

maxillofacial injury / hemorrhage / angiography，digital subtraction / refractory bleeding / transcatheter arterial embolization

基金资助

河南省医学科技攻关计划联合共建资助项目(LHGJ20210255)

河南省中青年卫生健康科技创新杰出青年人才培养资助项目(YXKC2022029)