Department of Visceral Surgery and Medicine, Inselspital, Berne University Hospital, and University of Berne, Switzerland.
Br J Surg. 2010 Nov;97(11):1696-703. doi: 10.1002/bjs.7203.
Non-operative management (NOM) of blunt splenic injuries is nowadays considered the standard treatment. The present study identified selection criteria for primary operative management (OM) and planned NOM.
All adult patients with blunt splenic injuries treated at Berne University Hospital, Switzerland, between 2000 and 2008 were reviewed.
There were 206 patients (146 men) with a mean(s.d.) age of 38.2(19.1) years and an Injury Severity Score of 30.9(11.6). The American Association for the Surgery of Trauma classification of the splenic injury was grade 1 in 43 patients (20.9 per cent), grade 2 in 52 (25.2 per cent), grade 3 in 60 (29.1 per cent), grade 4 in 42 (20.4 per cent) and grade 5 in nine (4.4 per cent). Forty-seven patients (22.8 per cent) required immediate surgery. Transfusion of at least 5 units of red cells (odds ratio (OR) 13.72, 95 per cent confidence interval 5.08 to 37.01), Glasgow Coma Scale score below 11 (OR 9.88, 1.77 to 55.16) and age 55 years or more (OR 3.29, 1.07 to 10.08) were associated with primary OM. The rate of primary OM decreased from 33.3 to 11.9 per cent after the introduction of transcatheter arterial embolization in 2005. Overall, 159 patients (77.2 per cent) qualified for NOM, which was successful in 143 (89.9 per cent). The splenic salvage rate was 69.4 per cent. In multivariable analysis age at least 40 years was the only factor independently related to failure of NOM (OR 13.58, 2.76 to 66.71).
NOM of blunt splenic injuries has a low failure rate. Advanced age is independently associated with an increased failure rate.
非手术治疗（NOM）如今被认为是钝性脾损伤的标准治疗方法。本研究旨在确定行脾切除术（OM）的选择标准和计划行 NOM 的标准。
回顾 2000 年至 2008 年期间在瑞士伯尔尼大学医院接受治疗的所有成人钝性脾损伤患者。
共有 206 名患者（146 名男性），平均（标准差）年龄为 38.2（19.1）岁，损伤严重度评分（ISS）为 30.9（11.6）。根据美国创伤外科学会（AAST）的脾损伤分级，43 例（20.9%）为 1 级，52 例（25.2%）为 2 级，60 例（29.1%）为 3 级，42 例（20.4%）为 4 级，9 例（4.4%）为 5 级。47 例（22.8%）患者需要立即手术。至少输注 5 个单位红细胞（优势比（OR）13.72，95%置信区间 5.08 至 37.01）、格拉斯哥昏迷评分（GCS）低于 11 分（OR 9.88，1.77 至 55.16）和年龄 55 岁或以上（OR 3.29，1.07 至 10.08）与行 OM 有关。2005 年引入经导管动脉栓塞术（TAE）后，行 OM 的比例从 33.3%降至 11.9%。总的来说，159 名（77.2%）患者适合行 NOM，143 名（89.9%）成功。脾保留率为 69.4%。多变量分析显示，年龄至少 40 岁是与 NOM 失败相关的唯一独立因素（OR 13.58，2.76 至 66.71）。
钝性脾损伤的 NOM 失败率较低。年龄较大与 NOM 失败率增加独立相关。
