Lännergren K, Tordai P, Linné T, Persson U
Department of Paediatric Surgery, St. Göran's Children's Hospital, Stockholm, Sweden.
Acta Chir Scand. 1990 May;156(5):359-65.
Ninety-two consecutive patients with traumatic rupture of the spleen were studied. Of the first 46 children (group A), 44 underwent splenectomy. In the subsequent group (group B) non-operative management was successful in 40 of 46 patients, five patients were operated with splenic repair, and one had the spleen removed. All the ruptures were caused by blunt trauma and the severity of the splenic injury was roughly the same in the two groups of patients. A third of the patients in each group had associated injuries, renal injury being the most common intraabdominal lesion. The median hospital stay was 8.0 days (range 5 to 28) in group A and 12.5 days (range 7 to 18) in group B. Among the 40 patients who were treated conservatively, a biphasic course was seen in 23: one or two days after the accident a period of increased pulse rate, fever and increased abdominal tenderness and pain followed, but no evidence for a delayed rupture was found. Our results of conservative treatment of splenic rupture are encouraging and show that non-operative management should be considered in most cases.
对92例连续性脾外伤性破裂患者进行了研究。在前46例儿童患者（A组）中，44例行脾切除术。在随后的一组患者（B组）中，46例患者中有40例非手术治疗成功，5例患者行脾修补术，1例患者脾脏被切除。所有破裂均由钝性创伤引起，两组患者脾损伤的严重程度大致相同。每组三分之一的患者有合并伤，肾损伤是最常见的腹腔内病变。A组患者的中位住院时间为8.0天（范围5至28天），B组为12.5天（范围7至18天）。在40例接受保守治疗的患者中，23例出现双相病程：事故发生后1至2天，出现脉搏加快、发热、腹部压痛和疼痛加剧的时期，但未发现延迟破裂的证据。我们对脾破裂保守治疗的结果令人鼓舞，表明在大多数情况下应考虑非手术治疗。
