Masoomi Hossein, Carmichael Joseph C, Mills Steven, Ketana Noor, Dolich Matthew O, Stamos Michael J
Department of Surgery, University of California, Irvine Medical Center, 333 City Blvd W, Ste 700, Orange, CA 92868, USA.
Arch Surg. 2012 Apr;147(4):324-9. doi: 10.1001/archsurg.2011.1010. Epub 2011 Dec 19.
To determine frequency of splenic injury and to evaluate predictive risk factors of splenic injury during colorectal surgery.
Retrospective database analysis.
The National Inpatient Sample database.
Patients who underwent a colorectal resection during the period from 2006 to 2008 in the United States.
Patient characteristics, patient comorbidities, type of pathology, type of resection, surgical technique used, type of admission, and teaching hospital status were evaluated for splenic injury during colorectal surgery.
A total of 975,825 patients underwent colorectal resection during this period. Overall, the rate of splenic injury was 0.96%, of which 84.75% were treated with complete splenectomy (splenorrhaphy, 13.55%; partial splenectomy, 1.70%). The most common procedure associated with splenic injury was transverse colectomy (3.40%). Using multivariate regression analysis, we found that transverse colectomy (adjusted odds ratio [AOR], 5.30), left colectomy (AOR, 5.08), total colectomy (AOR, 2.85), open operation (AOR, 2.68), malignant tumor (AOR, 2.11), diverticulitis (AOR, 1.93), teaching hospital (AOR, 1.73), male sex (AOR 1.20), peripheral vascular disease (AOR, 1.14), and emergent admission (AOR, 1.06) were associated with a higher risk of splenic injury. There was no association between age, race, hypertension, diabetes, chronic lung disease, congestive heart failure, renal failure, liver disease, obesity, sigmoidectomy, proctectomy, ulcerative colitis, or Crohn disease and splenic injury.
Type of resection (transverse, total, or left colectomy), type of pathology (malignancy or diverticulitis), open operation, and teaching hospital are potent independent predictors of splenic injury. Male sex, peripheral vascular disease, and emergent admission are less effective predictors. Surgeons should be aware of these risk factors and inform patients accordingly. In higher-risk circumstances, it may be appropriate to consider prophylactic vaccination.
确定结直肠手术中脾损伤的发生率，并评估脾损伤的预测风险因素。
回顾性数据库分析。
国家住院样本数据库。
2006年至2008年期间在美国接受结直肠切除术的患者。
评估患者特征、患者合并症、病理类型、切除类型、所采用的手术技术、入院类型和教学医院状况与结直肠手术中脾损伤的关系。
在此期间，共有975825例患者接受了结直肠切除术。总体而言，脾损伤发生率为0.96%，其中84.75%的患者接受了全脾切除术（脾修补术，13.55%；部分脾切除术，1.70%）。与脾损伤相关最常见的手术是横结肠切除术（3.40%）。通过多因素回归分析，我们发现横结肠切除术（校正比值比[AOR]，5.30）、左半结肠切除术（AOR，5.08）、全结肠切除术（AOR，2.85）、开放手术（AOR，2.68）、恶性肿瘤（AOR，2.11）、憩室炎（AOR，1.93）、教学医院（AOR，1.73）、男性（AOR 1.20）、外周血管疾病（AOR，1.14）和急诊入院（AOR，1.06）与脾损伤风险较高相关。年龄、种族、高血压、糖尿病、慢性肺病、充血性心力衰竭、肾衰竭、肝病、肥胖、乙状结肠切除术、直肠切除术、溃疡性结肠炎或克罗恩病与脾损伤之间无关联。
切除类型（横结肠、全结肠或左半结肠切除术）、病理类型（恶性肿瘤或憩室炎）、开放手术和教学医院是脾损伤的有力独立预测因素。男性、外周血管疾病和急诊入院是效果较差的预测因素。外科医生应了解这些风险因素并相应地告知患者。在高风险情况下，考虑预防性接种疫苗可能是合适的。
