Rappaport W, McIntyre K E, Carmona R
Department of Surgery, University of Arizona Health Sciences Center, Tucson 85724.
Surg Gynecol Obstet. 1990 Mar;170(3):204-8.
An analysis of 106 adult patients with blunt multiple organ injury and splenic trauma was carried out during an eight year period. Three groups were studied--group 1, splenectomy; group 2, splenorrhaphy, and group 3, observation. There was no statistically significant difference in initial blood pressure, pulse or hematocrit among the three groups. The mean injury severity score (ISS) was higher for those in groups 1 and 2 (26.8 and 25.6, respectively) versus patients in group 3 (17.9) (p). There were a total of 38 intra-abdominal injuries in 34 patients of which 21 required surgical repair. No patient in the nonoperative group required laparotomy for a missed associated intra-abdominal injury. There were a total of 15 intra-abdominal complications related to splenic management. In the observation group, seven patients ultimately required laparotomy for continued splenic bleeding. In the splenorrhaphy group, the complication rate was significantly lower versus the other two groups (p). We concluded that, if technically feasible, splenorrhaphy is a safe procedure in the multiply injured patient in the absence of hypotension and coagulopathy. Nonoperative management of blunt splenic trauma should be viewed with caution because of the high failure rate in the multiply injured patient.
在八年期间，对106例钝性多器官损伤合并脾外伤的成年患者进行了分析。研究分为三组：第一组，脾切除术；第二组，脾修补术；第三组，观察。三组患者的初始血压、脉搏或血细胞比容无统计学显著差异。第一组和第二组患者的平均损伤严重程度评分（ISS）较高（分别为26.8和25.6），而第三组患者为17.9（p值）。34例患者共有38处腹部损伤，其中21处需要手术修复。非手术组中没有患者因漏诊的相关腹部损伤而需要剖腹手术。共有15例与脾处理相关的腹部并发症。在观察组中，7例患者最终因脾持续出血而需要剖腹手术。在脾修补术组中，并发症发生率明显低于其他两组（p值）。我们得出结论，如果技术上可行，在无低血压和凝血功能障碍的多发伤患者中，脾修补术是一种安全的手术。由于多发伤患者的失败率较高，钝性脾外伤的非手术治疗应谨慎考虑。
