Occhionorelli Savino, Morganti Lucia, Andreotti Dario, Cappellari Lorenzo, Stano Rocco, Portinari Mattia, Vasquez Giorgio
Ann Ital Chir. 2015;86:413-20.
To identify patients with splenic injuries, who should benefit from a conservative treatment, and to compare inhospital follow-up and hospital length of stay (LOS), in patients treated by non-operative management (NOM) versus immediate-splenectomy (IS).
A retrospective cohort study on consecutive patients, with all grade of splenic injuries, admitted between November 2010 and December 2014 at the Acute Care Surgery Service of the S. Anna University Hospital of Ferrara. Patients were offered NOM or IS.
Fifty-four patients were enrolled; 29 (53.7%) underwent IS and 25 (46.3%) were offered NOM. Splenic artery angioembolization was performed in 9 patients (36%) among this latter group. High-grade splenic injuries (IVV) were more represented in IS group (65.5% vs 8%), while low grade (I-II) were more represented in NOM group (64% vs 10.3%). Failure of NOM occurred in 4 patients (16%). Hospital LOS was longer in IS group (p=0.044), while in-hospital and 30-day mortality were not statistically significant different between the two groups.
Hemodynamically stable patients, with grade I to III of splenic injuries, without other severe abdominal organ injuries, could benefit from a NOM; the in-hospital follow-up should be done, after a control CECT scan, with US. Observation and strictly monitoring of splenic injuries treated with NOM do not affect patients' hospital los.
Non-operative management, Splenic Rupture, Surgery.
确定可从保守治疗中获益的脾损伤患者，并比较非手术治疗（NOM）与即刻脾切除术（IS）治疗的患者的住院随访情况和住院时间（LOS）。
对2010年11月至2014年12月期间在费拉拉圣安娜大学医院急性护理外科就诊的所有级别的脾损伤连续患者进行回顾性队列研究。患者接受NOM或IS治疗。
共纳入54例患者；29例（53.7%）接受了IS治疗，25例（46.3%）接受了NOM治疗。后一组中有9例患者（36%）进行了脾动脉血管栓塞术。IS组中高级别脾损伤（IV-V级）更为常见（65.5%对8%），而NOM组中低级别（I-II级）更为常见（64%对10.3%）。4例患者（16%）NOM治疗失败。IS组的住院时间更长（p=0.044），而两组间的住院期间和30天死亡率无统计学显著差异。
血流动力学稳定、脾损伤为I至III级且无其他严重腹部器官损伤的患者可从NOM中获益；在进行对照CT增强扫描后，应使用超声进行住院随访。对接受NOM治疗的脾损伤进行观察和严格监测不会影响患者的住院时间。
非手术治疗；脾破裂；手术
