脾破裂的保脾治疗

Spleen-preserving treatment of traumatic splenic rupture

目的：对比选择性脾动脉栓塞术与非手术治疗外伤性脾破裂的临床应用。方法：回顾性分析1995～2006年进行的18例选择性脾动脉栓塞和30例非手术治疗脾破裂的患者。结果：选择性脾动脉栓塞组无输血,非手术组1例输血。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;非手术组1例出现并发脾周脓肿（P=0.298）。非手术组保脾成功率为81.3%（26/32）,选择性脾动脉栓塞组成功率为100%（23/23,P=0.035）。两组患者均无死亡病例。选择性脾动脉栓塞组平均住院（7.9±2.1）d,非手术组平均住院（11.9±4.6）d,P=0.045。结论：脾Ⅰ、Ⅱ级损伤适宜保脾治疗,选择性脾动脉栓塞术比非手术治疗更为安全有效。

Objective To compare selective splenic artery embolization （SSAE） with non - operative therapy of traumatic splenic rupture （TSR）. Method The clinical data of 18 patients with TSR receiving SSAE and 30 undergoing non - operative therapy between 1995 and 2006 in our hospital were retrospectively analyzed. Results There was no blood transfusion in SSAE group, and 1 patient was received it in the non - operative therapy group. Two patients in SSAE group had complications with left pleural effusion, and I had left pulmonary infection. One patient with non - operative therapy complicated with spleen abscess （ P = 0. 298）. The ratio of successful management in SSAE and non -operative group were 100% （23/23） and 81.3% （26/32） respectively （P = 0. 035）. All the patients in both groups were survival. The mean hospital days in non - operative group （ 11.9 ± 4.6） d were significantly longer than that in SSAE group （ 7.9 ± 2.1 ） d, （ P = 0.045）. Conclusion Splenic injuries with grade Ⅰ or Ⅱ are suitable for preserving spleen management. SSAE may be more safe and effective than non- operative therapy.