成人钝性脾损伤88例治疗分析

Management of adult blunt splenic injury in 88 cases

目的探讨成人钝性脾损伤处理中保守治疗的选择。方法选取88例成人钝性脾损伤患者,分为手术治疗、保守无效和保守成功3组,回顾性分析其保守治疗的情况并与手术治疗进行比较。结果手术治疗62例,保守无效7例,保守成功19例。手术组CT检出腹腔积液量、损伤严重度评分(ISS)和美国创伤外科协会(AAST)器官损伤分级均显著大于保守成功组(P=0.000、0.026和0.009),手术组的最低舒张压、最快心率、最低血红蛋白浓度和最低红细胞比容与保守成功组差异显著(P=0.044、0.003、0.038和0.008)。结论血液动力学状况稳定的轻中度钝性脾损伤患者适合保守治疗;保守治疗期间血液动力学状况不能维持稳定者需中转手术;急诊腹部CT有助于保守治疗的病例选择。

To evaluate the choice of nonoperative management for adult blunt splenic injury. Methods Eighty-eight cases of adult blunt splenic injury were selected and divided into 3 groups including group of operative management, successful nonoperative management and failed nonoperative management, and parameters of nonoperative management of blunt splenic injury were retrospectively analysed and compared with the operative management. Results Of all the 88 cases, there were 62, 7 and 19, respectively in group of operative management, successful and failed nonoperative management. Volume of hemoperitoneum, injury severity score （ISS） value and American Association for the Surgery of Trauma （AAST） organ injury scale value were significantly larger in group of operative management than in group of successful nonoperative management （ P = 0. 000, 0. 026 and 0. 009, respectively）. There were significant differences in lowest diastolic pressure, highest heart rate, Hb and Hct of group of operative management than those of successful nonoperative management（P = 0. 044, 0. 003, 0. 038 and 0. 008, respectively）. Conclusion Mild and moderate blunt splenic injuries with stable hemodynamics are appropriate for nonoperative management, and delayed operation is necessary when hemodynamic condition becomes unstable during the nonoperative management. Emergent abdominal CT examination may help to choose cases for nonoperative management.