延迟性脾破裂23例报道及其非手术治疗指征的探讨

Report of 23 cases of delayed rupture of spleen and discussion on nonoperative therapy

目的探讨延迟性脾破裂非手术治疗指征,以提高非手术治疗成功率。方法回顾性分析延迟性脾破裂23例临床资料。对23例患者的资料进行回顾性分析。比较手术组和非手术组的年龄、损伤严重评分(injury severity score,ISS)、输血量、ICU时间、住院时间、并发症和治疗效果等,结合文献资料,探讨延迟性脾破裂的非手术治疗的指征。结果非手术组患者年龄和损伤严重评分明显低于手术组,而在输血量、ICU时间、住院时间方面高于手术组。非手术组中有1例中转手术,手术组有2例出现伤口感染和脾热。23例患者均治愈。结论选择性非手术治疗延迟性脾破裂是一种安全有效的治疗手段,筛选制定的外伤性脾破裂非手术治疗指征对提高该病的非手术治疗成功率有很高的临床应用价值。

Objective To increase the curative rate of non-operative management for delayed rupture of spleen（DRS）. Methods The clinical data of 23 patients with DSR treated in our hospital from January 1991 to June 2007 were retrospectively analyzed. Tt（en the the age,injury severity score（ISS）, blood transfusion volume,length of stay in ICU,length of stay in ward, the complica tion and the outcome of the non-operative management group were compared with those of the operative group. Depending on litera ture,the indication of nonoperative management of I）RS was discussed. Results The age and ISS were significantly lower in the nonoperative management group, and blood transfusion volume,length of stay in ICU,length of stay in ward were higher than those of the operative group. There was one case of stopping nonoperative ti^erapy and receiving splenectomy. In the operative group,one case had wound infection and one case suffered splenic fever. The cases in both group were cured. Conclusion Nonoperative man agement of DRS is feasible and safe in a selected group of patients. The new indication effectively increases the curative rate of DRS by nonoperative management and is clinically applicable.