147例外伤性脾破裂治疗决策的影响因素分析

Logistic analysis of impact factors of treatment decision： a study on 147 patients with traumatic ruptured spleen

目的 了解市级医院外伤性脾破裂的治疗现状.方法 回顾2家三级医院147例外伤性脾破裂的临床资料,用logistic分析,研究16项影响因素与治疗方法的关系.结果 患者的受伤原因、入院脉搏、腹腔穿刺情况、CT分级与治疗决策有关.脾切除术89例,占总例数的60.54％,占手术例数的89.90％.CT分级1、2级脾破裂的50.85％行脾切除,占l、2级手术例数的85.71％.3级及以上脾切除率100％.保脾手术共7例,均为CT 1、2级；脾修补术1例.结论 该组资料外伤性脾破裂的治疗仍以脾切除术为主.为此,有必要在更大范围的二级以上医院进行外伤性脾破裂的治疗状况调查,应用更为可靠的手术技术实现CT 1、2级脾破裂的脾脏保留.

Objective To investigate the current status of treatment on traumatic ruptured spleen in a regional medical center in Tianjin,China.Method Logistic analysis of 16 impact ffactors of treatment decision on 147 patients with traumatic ruptured spleen.Results The type of trauma,pulse rate at admission,result of abdominal puncture and CT grade were related to treatment decision making.Splenectomy was carried out in 89 patients （60.54%） which accounted for 89.90% of all surgical procedures.Splenectomy was carried out in 50.85% of patients with CT grade 1 or 2 （or 85.71% of grade 1 and 2 surgery）,and 100% of CT grade 3 or 4.Spleen preservation surgery was carried out in 7 patients with CT grade 1 or 2.Conclusion Splenectomy was carried out in most cases in this study.It is necessary to investigate the treatment of splenic trauma in regional medical centers,and to develop more reliable surgical techniques to carry out more spleen-preservation surgery ffor CT grade 1 or 2 ruptured spleen.