保留脾脏治疗钝性脾破裂患者的并发症及随访

Long-term follow-up and complications after non-operative management of blunt splenic injury

目的:评估钝性脾破裂保守治疗并发症及随访结果。方法:选择2015-04-2018-04期间我院急诊外科收治钝性脾损伤保守治疗成功患者84例,保守治疗并发症发生率和其中获得随访病例61例,随访时间13~48个月。随访包括反复腹痛、便秘和腹泻及反复感染等不适主诉。结果:84例患者发生并发症有2例(2.4%),随访61例患者中有22例(36.1%)诉有不适症状,其中7例有腹痛表现,14例有腹泻或便秘症状,有2例出现反复感染,均表现呼吸道感染,在2例(3.3%)感染患者中有1例合并有腹痛表现。随访中腹痛患者在年龄、性别、AAST脾损伤分级、B超腹腔积血量等方面比较差异无统计学意义(P>0.05)。随访腹痛患者ISS评分(26.3±6.7)分,无腹痛(16.5±6.9)分,上述比较差异有统计学意义(P<0.05)。随访腹痛患者在腹腔引流血量(1296.7±936.2)mL,无腹痛患者(665.9±633.5)mL,比较差异有统计学意义(P<0.05)。患者在腹泻或便秘方面比较,均差异无统计学意义(P>0.05)。结论:钝性脾破裂保守治疗有1/3患者在远期随访有不适主诉,但无再次因本次疾病相关并发症入院患者,有反复腹痛不适患者创伤评分较没有症状的患者高,同样出现在腹腔引流血量较多患者,钝性脾破裂保守治疗是安全的。

Objective:To assess long-term symptoms and complications in patients undergoing successful non-operative management for splenic injury.Method:Long-term posttraumatic outcomes including chronic abdominal pain,irregular bowel movements,and recurrent infections were assessed using a specifically designed questionnaire and analyzed by univariable analysis.Result:Sixty-one out of 84 patients with blunt splenic injury undergoing successful non-operative management responded to the questionnaire.Median follow-up time was 28.9 months.Twenty-two(36.1%)patients complained of at least one of the following symptoms:7 cases of chronic abdominal pain,14 cases of irregular bowel movement and 2 cases of recurrent infections.No significant association between the above-mentioned symptoms and age,gender,AAST splenic injury grades(≥Ⅲ),amount of hemoperitoneum was found.ISS in patients with chronic pain was significantly higher than that in asymptomatic patients(26.3±6.7 vs.16.5±6.9,P<0.05).The drainage volume of abdominal blood in patients with chronic pain was more than that in asymptomatic patients(1296.7±936.2 vs.665.9±633.5,P<0.05).Conclusion:A third of patients with blunt splenic injury undergoing non-operative management reported long-term abdominal pain.All patients were not re-admitted.The non-operative management to blunt splenic injury is a safe and effective treatment.