创伤性脾破裂非手术治疗的指征和疗效分析

Indications and efficacy analysis of non-surgical management for with traumatic splenic rupture

目的分析总结创伤所致脾破裂非手术治疗的指征和临床效果。方法回顾性分析陆军军医大学大坪医院2006年1月-2015年12月收治的创伤性脾破裂49例患者临床资料,男性35例,女性14例;年龄19~61岁,平均38.2岁。对诊断情况(明确的创伤病史+彩超及CT等影像学检查基本能确诊及明确分级)及治疗效果(严格掌握治疗指征是非手术治疗的关键,包括无合并伤的单纯的创伤史,密切监测生命体征,经治疗后48h内病情无加重等)进行分析。结果根据损伤程度分级:Ⅰ级31例(63.27%),Ⅱ级15例(30.61%),Ⅲ级3例(6.12%)。非手术治疗45例,治愈成功率为91.84%;4例(8.16%)在非手术治疗过程中中转手术,无死亡病例。结论创伤性脾破裂病情凶险、多变,应按照脾脏损伤的级别及病情变化合理把握非手术和手术治疗指征。

Objective To analyze the indications and treatment effect of non-surgical treatment for patients with traumatic splenic rupture.Methods Retrospective analysis of the clinical data of patients with traumatic splenic rupture admitted to our hospital from Jan.2006 to Dec.2015,including 35 males and 14 females with an average age of 38.2 years(ranged from 19 to 61 years).The diagnosis(history of trauma,color ultrasound and CT imaging can be confirmed and clearly graded)and treatment effect(strict control of indications for treatment is the key to non-surgical treatment;including a history of simple trauma without combined injuries,monitoring of vital vital signs,and no exacerbation within 48 hours of treatment,etc.)were analyzed.Results All patients were graded according to the degree of injury:31 patients(63.27%)at grade I,15 patients(30.61%)at grade II,and 3 patients(6.12%)at grade III.In 45 cases of non-surgical treatment,the cure rate was 91.84%;4 cases(8.16%)were transferred to surgury treatment during conservative treatment without death.Conclusion Traumatic splenic rupture is dangerous and unstable,it should be treated reasonably with non-operation and operation according to grade on spleen injury,patients’condition and indications of treatment.