闭合性腹部损伤脾破裂非手术治疗的探讨

Experience in nonoperative management of adult blnnt splenic injury

目的探讨闭合性腹部创伤脾破裂非手术治疗的可行性。方法对１９９５年１月至１９９７年３月间行手术和非手术治疗的３２倒闭合性腹部创伤脾破裂患者的临床表现和治疗结果进行回顾性分析。结果脾破裂非手术治疗患者１２例占同期脾破裂病例的３７．５％（１２／３２），男１０例，女２例，平均年龄３５岁（１６～５０岁）。非手术组患者其损伤程度较手术组患者轻。非手术治疗失败１例，治疗成功率９２％。平均住院日为１６天，出院随访１～２７个月未发现有并发症，其中１０例随访３个月以上，其ＣＴ检查示脾脏损伤均已愈合。结论合适的选择脾破裂患者行非手术治疗是安全、有效的。

Objective To summarize the experience in nonoperative managarent of adult blunt splenic injury. Methods thirty-two cases of adult blunt splenic injury having been managed operatively or nonoperativelyfrom January 1995 to March 1997 in a monitored setting were analysed. The indication for nonoperative management was based on clinical and laboratory parameters, and computed tomography grading of splenic injury. ResultsTwelve patients were treated by nonoperative managment to 37.5% (12/32) in this period, including10 males and two females, with a mean age of 35 years (range: 16 to 50 years). The patients managed nonoperatively were less severely mimed than those managed operatively. Nonsurgical therapy failed in one patient. Thepercentage of patients who were successfully treated without operation was 92% and the mean length of boitalization was 16 days. The patients were followed up for one to 27 months and complications were noted. In 10 cases, at three months postinjury the following-up CT scan showed complete resolution of the splenic injury. Conclusion Selective nonoperative management in adult patients with splenic injury can be done safely in a monitoredsetting.