Summary of eligible studies.

IntroductionSevere pelvic hemorrhage significantly contributes to mortality in trauma patients, yet the most effective treatment for severe pelvic injuries remains unclear. This systematic review evaluates the mortality and morbidity associated with bilateral internal iliac artery ligation (BIIAL) in patients experiencing severe hemorrhage from traumatic pelvic fractures.MethodsComprehensive searches were conducted in MEDLINE PubMed, EMBASE, and Cochrane databases until February 7, 2024, to identify relevant articles. The risk of bias in observational studies was assessed using the ROBINS-I tool, which evaluates bias risk in nonrandomized intervention studies. The primary outcome was mortality following BIIAL, with the secondary outcome being complications related to the procedure.ResultsThe review included eight studies, all observational. The overall mortality rate after BIIAL ranged from 45.0% to 76.9%. Ischemic complications from BIIAL were infrequent. A high and unclear risk of bias due to confounding and participant selection was noted across the studies. Four studies highlighted distinct indications for BIIAL compared to angioembolization. BIIAL was employed for patients with severe hemodynamic instability or when angiography was not available.ConclusionDue to geographical limitations and significant heterogeneity among the studies reviewed, the true effect size of BIIAL remains indeterminate. Nevertheless, further prospective studies with robust designs are necessary. BIIAL holds potential as a viable option when angioembolization is not accessible or in cases of critical patient instability.

引言 创伤患者的重度盆腔大出血是导致其死亡的重要诱因之一，但目前针对重度骨盆损伤的最优治疗方案仍不明确。本系统评价旨在探讨双侧髂内动脉结扎术（bilateral internal iliac artery ligation, BIIAL）应用于创伤性骨盆骨折伴重度大出血患者时，与该手术相关的病死率及并发症发生率。方法 本研究于2024年2月7日前在MEDLINE、PubMed、EMBASE及Cochrane数据库中开展全面检索，以筛选相关文献。采用ROBINS-I工具（非随机干预研究偏倚风险评价工具）对观察性研究的偏倚风险进行评估。本研究的主要结局指标为接受BIIAL术后的病死率，次要结局指标为该手术相关的并发症发生情况。结果 本系统评价共纳入8项观察性研究。BIIAL术后的总体病死率范围为45.0%至76.9%。该手术相关的缺血性并发症较为少见。纳入的各项研究均存在因混杂因素与受试者选择偏倚导致的高且不确定的偏倚风险。其中4项研究指出，与血管栓塞术（angioembolization）相比，BIIAL具有独特的临床适应证，多用于重度血流动力学不稳定的患者，或无法开展血管造影术的情形。结论 由于纳入研究存在地域局限性及显著的异质性，目前BIIAL的真实效应量仍无法确定。不过，仍需开展设计严谨的前瞻性研究以进一步明确其临床价值。在无法实施血管栓塞术，或患者出现重度血流动力学不稳定时，BIIAL不失为一种可行的治疗选择。