成人外伤性脾破裂非手术治疗55例分析

Nonoperative treatment for splenic rupture in 55 cases

目的对非手术治疗外伤性脾破裂进行临床分析,为外伤性脾破裂临床治疗方法的选择提供初步证据。方法回顾1992年至2006年我院收治的包括选择性脾动脉栓塞和保守治疗的非手术治疗脾破裂患者55例,对治疗成功率、死亡率和并发症发生率进行分析比较,并评价其卫生经济学效益。结果治疗总成功率87.27%(48/55),无患者死亡。损伤严重程度分组,51例脾Ⅰ、Ⅱ级损伤,总有效率90.19%(46/51),再次栓塞或开腹手术5例。4例脾外伤Ⅲ级患者,2例非手术治疗成功,再次栓塞或开腹手术2例。治疗分组分析,传统保守治疗组保脾成功率为81.3%(26/32),选择性脾动脉栓塞组成功率为100%(23/23)(P=0.035)。选择性脾动脉栓塞组2例并发左侧胸腔积液,1例并发左下肺感染;保守治疗组1例并发脾周脓肿。选择性脾动脉栓塞组平均住院日较保守治疗组[(7.9±2.1)d比(11.9±4.6)d]明显缩短(P=0.045),但住院花费增加[(4216±668.4)元比(2616±437.8)元](P<0.05)。结论脾损伤Ⅰ、Ⅱ级患者适宜保脾治疗,选择性脾动脉栓塞术比传统非手术保守治疗疗效更为可靠,在医疗设备和经济条件允许的情况下建议考虑栓塞治疗。

Objective To clinically analyze the nonoperative treatment for splenic rupture. Methods Fifty -five patients subject to nonoperative treatments for splenic rupture between 1992 and 2006 were retrospectively. Results Total effective rate of primary treatment was 87.27% （ 48/55 ）. In 51 eases of grade Ⅰ and Ⅱ injury,total effective rate was 90.19% and 5 patients underwent abdominal operation or second splenic vascular embolization. In 4 eases of grade Ⅲ injury,2 patients were subjected to abdominal operation or second splenic vascular embolization. Successful rate of spleen reservation was higher [100% （23/23） ] in splenic vascular embolization group than that in traditional group [81.3% （26/32） ] （P = 0. 035）. There were some side effects such as left pleural effusions of 2 patients, bottom left lung infection of 1 patient in splenic vascular embolization group, and abdominal cavity abscess of 1 patient in traditional treatment group （ P 〉 0.05 ）. In splenic vascular embelization group, the average hos- pital stay was significantly shortened, but hospitalization cost increased as compared with traditional treatment group （P 〈0.05）. Conclusion Splenic rupture with grade Ⅰ and Ⅱ may be given priority to nonoperative therapy. When medical armamentarium and economic condition is permitted, splenic vascular embelization should be applied for higher successful rate of spleen reservation.