Furlan Alessandro, Tublin Mitchell E, Rees Mitchell A, Nicholas Dederia H, Sperry Jason L, Alarcon Louis H
Department of Radiology, University of Pittsburgh Medical Center and School of Medicine, Pittsburgh, Pennsylvania.
Department of Radiology, University of Pittsburgh Medical Center and School of Medicine, Pittsburgh, Pennsylvania.
J Surg Res. 2017 May 1;211:87-94. doi: 10.1016/j.jss.2016.11.062. Epub 2016 Dec 22.
Delayed splenic vascular injury (DSVI) is traditionally considered a rare, often clinically occult, harbinger of splenic rupture in patients with splenic trauma that are managed conservatively. The purpose of our study was to assess the incidence of DSVI and associated features in patients admitted with blunt splenic trauma and managed nonoperatively.
A retrospective analysis was conducted over a 4-y time. Patients admitted with blunt splenic trauma, managed no-operatively and with a follow-up contrast-enhanced computed tomography (CT) scan study during admission were included. The CT scans were reviewed for American Association for the Surgery of Trauma splenic injury score, amount of hemoperitoneum, and presence of DSVI. Logistic regression models were used to investigate the risk factors associated with DSVI.
A total of 100 patients (60 men and 40 women) constituted the study group. Follow-up CT scan demonstrated a 23% incidence of DSVI. Splenic artery angiography validated DSVI in 15% of the total patient population. Most DSVIs were detected only on arterial phase CT scan imaging. The American Association for the Surgery of Trauma splenic injury score (odds ratio = 1.73; P = 0.045) and the amount of hemoperitoneum (odds ratio = 1.90; P = 0.023) on admission CT scan were associated with the development of DSVI on follow-up CT scan.
DSVI on follow-up CT scan imaging of patients managed nonoperatively after splenic injury is common and associated with splenic injury score assessed on admission CT scan.
延迟性脾血管损伤（DSVI）传统上被认为是一种罕见的、临床上常隐匿的、保守治疗的脾外伤患者脾破裂的先兆。我们研究的目的是评估钝性脾外伤患者非手术治疗后DSVI的发生率及相关特征。
进行了为期4年的回顾性分析。纳入钝性脾外伤、非手术治疗且入院期间接受了随访增强CT扫描研究的患者。对CT扫描结果进行评估，记录美国创伤外科学会脾损伤评分、腹腔积血量及DSVI的存在情况。采用逻辑回归模型研究与DSVI相关的危险因素。
研究组共100例患者（60例男性，40例女性）。随访CT扫描显示DSVI发生率为23%。脾动脉血管造影证实15%的患者存在DSVI。大多数DSVI仅在CT扫描动脉期成像中被检测到。入院时CT扫描的美国创伤外科学会脾损伤评分（比值比=1.73；P=0.045）和腹腔积血量（比值比=1.90；P=0.023）与随访CT扫描时DSVI的发生相关。
脾损伤后非手术治疗患者随访CT扫描成像中的DSVI很常见，且与入院时CT扫描评估的脾损伤评分相关。
