闭合性肝脾损伤25例非手术治疗效果分析

Nonoperative management of 25 patients with blunt hepatic and splenic injury

目的分析探讨闭合性肝脾损伤非手术治疗(nonoperative management,NOM)的方法、效果及适应证。方法 25例采用NOM治疗的闭合性肝脾损伤患者中,肝损伤8例,损伤程度Ⅰ级1例,Ⅱ级2例,Ⅲ级3例,Ⅳ级2例,肝右叶伤6例,肝左叶伤2例;脾损伤17例,损伤程度Ⅰ级2例,Ⅱ级4例,Ⅲ级11例。非手术治疗包括积极输液、止血、输血、抗炎、ICU监测等,部分患者辅助动脉栓塞介入治疗。结果 NOM治愈22例,成功率为88%,无并发症发生。1例因脾包膜下血肿延迟破裂出血中转手术治疗;2例因脾损伤活动性出血行经导管脾动脉栓塞治疗,其中死亡1例。结论闭合性肝脾损伤非手术治疗安全、有效,多数血流动力学稳定的患者NOM可治愈,但需在重症监护条件下严密观察、随访,如出现手术指征须及时中转手术治疗。动脉介入栓塞治疗可增加NOM成功率。

Objective To analyse and explore the methods, effects and indications of nonoperative management （NOM） of blunt hepatic and splenic injury. Methods To analyse retrospectively the 25 cases of blunt hepatic and splenic injury and treated by NOM,including 8 cases of hepatic injury, among them, 1 case of grade I , 2 cases of gradeⅡ, 3 cases of grade Ⅲ, 2 cases of gradeⅣ, and 6 cases of right hepatic lobe injury, 2 cases of left hepatic lobe injury and 17 cases of splenic injury, among them,2 case of gradeI,4 cases of grade Ⅱ and 11 cases of grade Ⅲ. NOM included active blood transfusion, hemostasis, anti-in- flammatory treatment, ICU monitoring, and so on. Partial cases were carried out auxiliary artery embolization interventional treatment. Results 22 cases were cured by conservative management with the success rate of 88% （22/25） and Without complications. 1 case was converted to operation because of the delayed and cracked bleeding of spleen subcapsular hematoma. 2 cases of splenic injury were carried out splenic artery embolism via catheter because of active bleeding andl case died. Conclusion NOM for blunt hepatic and splenic injury is safe and effective. The majority of patients with stable haemodynamics can be cured by NOM. However, these patients must be rigorously monitored as well as followed up under intensive care conditions and should be converted to operation at the appearance of operation indications. The artery embolization interventional treatment can increase the success rate of NOM.