外伤性脾破裂的诊断与三阶梯治疗研究进展

Research Progress in Diagnosis and Three-tiered Treatment of Traumatic Splenic Rupture

外伤性脾破裂的诊断首选多层螺旋CT(multislice spiral computed tomography,MSCT),扩展创伤超声重点评估、MRI、血红蛋白浓度监测可与其互为补充。伤情判定主要依据美国创伤外科协会脾外伤5级评估标准和中华医学会外科学分会脾外伤4级评估标准。三阶梯治疗策略包括非手术治疗、腹腔镜手术治疗和开腹手术治疗3个层级,依据血流动力学状态、创伤分级标准、是否合并其他脏器伤等因素筛选分层治疗方法,有利于减少手术创伤及其并发症,提高无创及微创治愈率。

Multislice spiral computed tomography is the preferred diagnostic modality for traumatic splenic rupture.Supplementary diagnostic evaluations include extended focused assessment with sonography for trauma(eFAST),magnetic resonance imaging(MRI),and continuous monitoring of hemoglobin concentration.Injury severity assessment adheres to the American Association for the Surgery of Trauma 5-grade spleen injury classification and the 4-grade spleen injury criteria set forth by the Surgical Branch of the Chinese Medical Association.The therapeutic approach is stratified into three tiers:non-operative management,laparoscopic surgery,and open surgical intervention.The selection of an appropriate treatment modality is contingent upon several criteria,including the patient's hemodynamic status,the established trauma grading,and the concomitant involvement of other organs.This tiered strategy aims to mitigate surgical trauma and associated complications while optimizing outcomes through the adoption of non-invasive or minimally invasive treatment methodologies.