Wei Benjamin, Hemmila Mark R, Arbabi Saman, Taheri Paul A, Wahl Wendy L
Department of Surgery, Henry Ford Health System Detroit, Michigan, USA.
J Trauma. 2008 Jun;64(6):1472-7. doi: 10.1097/TA.0b013e318174e8cd.
Nonoperative management for blunt splenic injury (BSI) has become gold standard, but the role of angiographic embolization (AE) is still controversial for bleeding. We postulated that splenic AE for BSI would have superior outcomes compared with operation and increase our splenic salvage rate.
This was a retrospective study of all adult trauma patients admitted to our Level I center from 2000 through 2006. Multivariate analysis adjusting for age, Injury Severity Score, and Glasgow Coma Scale score was performed. Only patients who had a computed tomographic (CT) scan before surgery (CT + OR) were compared with those who had CT scans then AE.
Eighty-seven of 317 patients required initial intervention for their BSI, for a no intervention rate (no OR or AE) of 73% and a nonoperative rate of 89%. The groups had similar Injury Severity Score, mortality, and lengths of stay. The AE group was older (p < 0.01), had higher spleen Abbreviated Injury Score (p = 0.02), and required significantly fewer packed RBC transfusions, p < 0.01. The overall hospitalization costs were not different, but the number of intraabdominal complications was higher for the CT + OR group (36% vs. 6%, p < 0.01). Pneumonia, thromboembolic events, and pleural effusions were equivalent. There were no deaths from splenic hemorrhage.
Despite recent concerns that AE may be overutilized for BSI, this study showed a lower incidence of abdominal complications and blood utilization in the AE group despite an older age and higher splenic Abbreviated Injury Score. Use of AE decreased operative intervention by 16%.
钝性脾损伤（BSI）的非手术治疗已成为金标准，但血管造影栓塞术（AE）在治疗出血方面的作用仍存在争议。我们推测，与手术相比，BSI的脾AE治疗效果更佳，且能提高我们的脾脏保留率。
这是一项对2000年至2006年入住我们一级中心的所有成年创伤患者的回顾性研究。进行了年龄、损伤严重程度评分和格拉斯哥昏迷量表评分的多因素分析。仅将术前进行计算机断层扫描（CT）（CT + OR）的患者与先进行CT扫描然后接受AE治疗的患者进行比较。
317例患者中有87例因BSI需要初始干预，无干预率（无OR或AE）为73%，非手术率为89%。两组的损伤严重程度评分、死亡率和住院时间相似。AE组患者年龄较大（p < 0.01），脾脏简化损伤评分较高（p = 0.02），且所需浓缩红细胞输注明显较少（p < 0.01）。总体住院费用无差异，但CT + OR组的腹腔内并发症数量较高（36%对6%，p < 0.01）。肺炎、血栓栓塞事件和胸腔积液情况相当。无因脾出血导致的死亡。
尽管近期有人担心AE可能在BSI治疗中被过度使用，但本研究表明，尽管AE组患者年龄较大且脾脏简化损伤评分较高，但腹腔并发症和血液使用发生率较低。使用AE使手术干预减少了16%。
