Skattum Jorunn, Loekke Ruth Jeanette Vaaler, Titze Thomas Larsen, Bechensteen Anne Grete, Aaberge Ingeborg S, Osnes Liv Toril, Heier Hans Erik, Gaarder Christine, Naess Paal Aksel
Department of Traumatology, Oslo University Hospital Ulleval, PO Box 4950, Nydalen, N-0424 Oslo, Norway.
Injury. 2014 Jan;45(1):156-9. doi: 10.1016/j.injury.2012.10.036. Epub 2012 Dec 14.
Non-operative management for blunt splenic injuries was introduced to reduce the risk of overwhelming post splenectomy infection in children. To increase splenic preservation rates, splenic artery embolization (SAE) was added to our institutional treatment protocol in 2002. In the presence of clinical signs of ongoing bleeding, SAE was considered also in children. To our knowledge, the long term splenic function after SAE performed in the paediatric population has not been evaluated and constitutes the aim of the present study.
A total of 11 SAE patients less than 17 years of age at the time of injury were included with 11 healthy volunteers serving as matched controls. Clinical examination, medical history, general blood counts, immunoglobulin quantifications and flowcytometric analysis of lymphocyte phenotypes were performed. Peripheral blood smears were examined for Howell-Jolly bodies (H-J bodies) and abdominal ultrasound was performed in order to assess the size and perfusion of the spleen.
On average 4.6 years after SAE (range 1-8 years), no significant differences could be detected between the SAE patients and their controls. Total and Pneumococcus serospecific immunoglobulins and H-J bodies did not differ between the study groups, nor did general blood counts and lymphocyte numbers, including memory B cell proportions. The ultrasound examinations revealed normal sized and well perfused spleens in the SAE patients when compared to their controls.
This case control study indicates preserved splenic function after SAE for splenic injury in children. Mandatory immunization to prevent severe infections does not seem warranted.
钝性脾损伤的非手术治疗旨在降低儿童脾切除术后暴发性感染的风险。为提高脾脏保留率，2002年我们在机构治疗方案中增加了脾动脉栓塞术（SAE）。对于有持续出血临床体征的儿童，也考虑采用SAE。据我们所知，儿科人群中SAE术后的长期脾功能尚未得到评估，而这正是本研究的目的。
共纳入11例受伤时年龄小于17岁的SAE患者，并选取11名健康志愿者作为匹配对照。进行了临床检查、病史询问、全血细胞计数、免疫球蛋白定量以及淋巴细胞表型的流式细胞术分析。检查外周血涂片以观察豪-焦小体（H-J小体），并进行腹部超声检查以评估脾脏大小和灌注情况。
SAE术后平均4.6年（范围1 - 8年），SAE患者与其对照之间未检测到显著差异。研究组之间的总免疫球蛋白和肺炎球菌血清特异性免疫球蛋白以及H-J小体无差异，全血细胞计数和淋巴细胞数量，包括记忆B细胞比例也无差异。超声检查显示，与对照相比，SAE患者的脾脏大小正常且灌注良好。
本病例对照研究表明，儿童脾损伤SAE术后脾功能得以保留。似乎无需强制免疫以预防严重感染。
