Requarth Jay A, D'Agostino Ralph B, Miller Preston R
Section of Vascular and Interventional Radiology, Department of Radiologic Sciences, Wake Forest University Baptist Medical Center, Winston Salem, North Carolina 27157, USA.
J Trauma. 2011 Oct;71(4):898-903; discussion 903. doi: 10.1097/TA.0b013e318227ea50.
Observation and splenic artery embolotherapy (SAE) are nonoperative management (NOM) modalities for adult blunt splenic injury; however, they are quite different, inconsistently applied, and controversial. This meta-analysis compares the known outcomes data for observational management versus SAE by splenic injury grade cohort.
Thirty-three blunt splenic injury outcomes articles, published between 1994 and 2009, comprising 24 unique data sets are identified. Of these, nine gave outcomes data by splenic injury grade for observational management and SAE separately. Failure rates were collected and analyzed using random effects estimates.
Overall, 68.4% of the 10,157 patients were managed nonoperatively. The overall failure rate estimate of NOM is 8.3% with a 95% confidence interval (CI) of 6.7% to 10.2%. The observational management failure rate estimate without SAE increases from 4.7% to 83.1% in splenic injury grade 1 to 5 patients. The overall failure rate estimate of SAE is 15.7% (95% CI, 10.4-23.2) and did not vary significantly from splenic injury grades 1 to 5 (p=0.413). The failure rate of observational management without SAE is statistically higher than the failure rare estimate of SAE in splenic injury grade 4 and 5 injuries: 43.7% (95% CI, 25.5-63.8) versus 17.3% (95% CI, 7.8-34.1), p=0.035 and 83.1% (95% CI, 45.2-96.7) versus 25.0% (95% CI, 8.7-53.8), p=0.016, respectively.
This meta-analysis synthesizes NOM outcomes data by modality and splenic injury grade. The failure rate of observational management increases with splenic injury grade, whereas the failure rate of SAE does not change significantly. SAE is associated with significantly higher splenic salvage rates in splenic injury grade 4 and 5 injuries.
观察和脾动脉栓塞疗法（SAE）是成人钝性脾损伤的非手术治疗（NOM）方式；然而，它们差异很大，应用不一致且存在争议。本荟萃分析按脾损伤分级队列比较了观察性治疗与SAE已知的结局数据。
确定了1994年至2009年间发表的33篇钝性脾损伤结局文章，包含24个独立数据集。其中，9篇分别给出了观察性治疗和SAE按脾损伤分级的结局数据。收集失败率并使用随机效应估计进行分析。
总体而言，10157例患者中有68.4%接受了非手术治疗。NOM的总体失败率估计为8.3%，95%置信区间（CI）为6.7%至10.2%。在1至5级脾损伤患者中，未进行SAE的观察性治疗失败率估计从4.7%增至83.1%。SAE的总体失败率估计为15.7%（95%CI，10.4 - 23.2），在1至5级脾损伤中无显著差异（p = 0.413）。在4级和5级脾损伤中，未进行SAE的观察性治疗失败率在统计学上高于SAE的失败率估计：分别为43.7%（95%CI，25.5 - 63.8）对17.3%（95%CI，7.8 - 34.1），p = 0.035；以及83.1%（95%CI，45.2 - 96.7）对25.0%（95%CI，8.7 - 53.8），p = 0.016。
本荟萃分析按治疗方式和脾损伤分级综合了NOM结局数据。观察性治疗的失败率随脾损伤分级增加，而SAE的失败率无显著变化。在4级和5级脾损伤中，SAE与显著更高的脾挽救率相关。
