对于儿科钝性脾损伤，如果观察治疗失败，栓塞是脾切除的替代方法。
Embolization for pediatric blunt splenic injury is an alternative to splenectomy when observation fails.
机构信息
From the Departments of Surgery (J.L.G., N.L.W., C.A.H., R.J.S., A.P.K., C.P.C.), and Radiology (C.P.), Geisinger Medical Center, Danville, Pennsylvania.
出版信息
J Trauma Acute Care Surg. 2013 Sep;75(3):421-5. doi: 10.1097/TA.0b013e3182995c70.
BACKGROUND
Management of splenic injury has shifted from operative to nonoperative management in both children and adults with reports of high success rates. Benefits of splenic conservation include decreased hospital stay, blood transfusion, and mortality, as well as avoidance of infectious complications. Angiography with embolization is an innovative adjunct to nonoperative management and has resulted in increased splenic salvage in adults; however, data in the pediatric population are scant.
METHODS
A retrospective comparative study of a single-hospital trauma registry reviewed from 1999 to 2009. Patients 18 years and younger admitted with injury to the spleen were included. Children with penetrating injury were excluded. Children were divided into three categories by initial treatment: observation, embolization, or splenectomy. Data recorded include age, radiographic grade of injury, and Injury Severity Score (ISS). Groups were analyzed for success of initial treatment, requirement for transfusion of packed red blood cells, splenic salvage, and mortality.
RESULTS
Registry review identified 259 children with blunt splenic injury. Initial treatment was observation in 227, embolization in 15, and splenectomy in 17. In the observation group, 9 (4%) of 227 children failed initial treatment; 8 of these underwent embolization, while 1 unerwent splenectomy. In the embolization group, 1 (7%) of 15 failed initial treatment and underwent splenectomy. Blood transfusion was required by 38 (17%) of 227 in the observation group, 6 (40%) of 15 (p = 0.02) in the embolization group, and 15 (88%) of 17 (p < 0.01) in the splenectomy group. Overall splenic salvage rate was 237 (92%) of 259. Three children died in the observation group, and four children died in the splenectomy group. There was no death in the embolization group.
CONCLUSION
Splenic artery embolization for blunt trauma in children is associated with a higher blood transfusion rate compared with observation but offers a safe, intermediate alternative to splenectomy when observation fails.
LEVEL OF EVIDENCE
Therapeutic study, level IV.
背景
在儿童和成人中，脾损伤的治疗已从手术转为非手术治疗，报告显示成功率很高。保留脾脏的好处包括减少住院时间、输血和死亡率，以及避免感染并发症。血管造影栓塞术是一种非手术治疗的创新辅助手段，已导致成人脾脏存活率增加；然而，儿科人群的数据很少。
方法
对 1999 年至 2009 年期间的单一医院创伤登记处进行回顾性比较研究。纳入年龄在 18 岁及以下、因脾损伤而入院的患者。排除穿透性损伤的儿童。儿童根据初始治疗分为观察、栓塞或脾切除术三组。记录的数据包括年龄、放射学损伤程度和损伤严重程度评分（ISS）。对各组初始治疗的成功率、需要输注浓缩红细胞、脾脏保存和死亡率进行分析。
结果
登记处回顾确定了 259 例钝性脾损伤儿童。227 例接受观察治疗，15 例接受栓塞治疗，17 例接受脾切除术治疗。在观察组中，227 例中有 9 例（4%）初始治疗失败；其中 8 例接受栓塞治疗，1 例接受脾切除术。在栓塞组中，1 例（7%）初始治疗失败，接受脾切除术。观察组中有 38 例（17%）需要输血，栓塞组中有 6 例（40%）（p = 0.02），脾切除组中有 15 例（88%）（p < 0.01）。总体脾脏保存率为 259 例中的 237 例（92%）。观察组中有 3 例儿童死亡，脾切除组中有 4 例儿童死亡。栓塞组无死亡。
结论
儿童钝性脾损伤动脉栓塞与观察相比，输血率较高，但在观察失败时，是一种安全的、中等程度的替代脾切除术的方法。
证据水平
治疗研究，IV 级。
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