Olthof D C, Sierink J C, van Delden O M, Luitse J S K, Goslings J C
Trauma Unit Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Injury. 2014 Jan;45(1):95-100. doi: 10.1016/j.injury.2012.12.021. Epub 2013 Jan 31.
Timely intervention in patients with splenic injury is essential, since delay to treatment is associated with an increased risk of mortality. Transcatheter Arterial Embolisation (TAE) is increasingly used as an adjunct to non-operative management. The aim of this study was to report time intervals between admission to the trauma room and start of intervention (TAE or splenic surgery) in patients with splenic injury.
Consecutive patients with splenic injury aged ≥ 16 years admitted between January 2006 and January 2012 were included. Data were reported according to haemodynamic status (stable versus unstable). In haemodynamically (HD) unstable patients, transfusion requirement, intervention-related complications and the need for a re-intervention were compared between the TAE and splenic surgery group.
The cohort consisted of 96 adults of whom 16 were HD unstable on admission. In HD stable patients, median time to intervention was 105 (IQR 77-188) min: 117 (IQR 78-233) min for TAE compared to 95 (IQR 69-188) for splenic surgery (p=0.58). In HD unstable patients, median time to intervention was 58 (IQR 41-99) min: 46 (IQR 27-107) min for TAE compared to 64 (IQR 45-80) min for splenic surgery (p=0.76). The median number of transfused packed red blood cells was 8 (3-22) in HD unstable patients treated with TAE versus 24 (9-55) in the surgery group (p=0.09). No intervention-related complications occurred in the TAE group and one in the splenic surgery group (p=0.88). Two spleen related re-interventions were performed in the TAE group versus 3 in the splenic surgery group (p=0.73).
Time to intervention did not differ significantly between HD unstable patients treated with TAE and patients treated with splenic surgery. Although no difference was observed with regard to intervention-related complications and the need for a re-intervention, a trend towards lower transfusion requirement was observed in patients treated with TAE compared to patients treated with splenic surgery. We conclude that if 24/7 interventional radiology facilities are available, TAE is not associated with time loss compared to splenic surgery, even in HD unstable patients.
对于脾损伤患者，及时干预至关重要，因为延迟治疗会增加死亡风险。经导管动脉栓塞术（TAE）越来越多地被用作非手术治疗的辅助手段。本研究的目的是报告脾损伤患者从进入创伤室到开始干预（TAE或脾手术）的时间间隔。
纳入2006年1月至2012年1月期间收治的年龄≥16岁的连续性脾损伤患者。根据血流动力学状态（稳定与不稳定）报告数据。在血流动力学（HD）不稳定的患者中，比较TAE组和脾手术组的输血需求、干预相关并发症及再次干预的必要性。
该队列包括96名成年人，其中16名入院时HD不稳定。在HD稳定的患者中，干预的中位时间为105（IQR 77 - 188）分钟：TAE组为117（IQR 78 - 233）分钟，脾手术组为95（IQR 69 - 188）分钟（p = 0.58）。在HD不稳定的患者中，干预的中位时间为58（IQR 41 - 99）分钟：TAE组为46（IQR 27 - 107）分钟，脾手术组为64（IQR 45 - 80）分钟（p = 0.76）。接受TAE治疗的HD不稳定患者输注浓缩红细胞的中位数为8（3 - 22）单位，而手术组为24（9 - 55）单位（p = 0.09）。TAE组未发生干预相关并发症，脾手术组发生1例（p = 0.88）。TAE组进行了2次与脾相关的再次干预，脾手术组为3次（p = 0.73）。
TAE治疗的HD不稳定患者与脾手术治疗的患者之间，干预时间无显著差异。虽然在干预相关并发症和再次干预的必要性方面未观察到差异，但与脾手术治疗的患者相比，TAE治疗的患者输血需求有降低的趋势。我们得出结论，如果有全天候的介入放射学设备，即使在HD不稳定的患者中，与脾手术相比，TAE也不会造成时间延误。
