Department of Trauma, University Medical Centre Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands.
Department of Trauma, Tygerberg Hospital (University of Stellenbosch), Francie van Zijl Avenue, Cape Town, 7505 South Africa.
World J Emerg Surg. 2017 Jul 25;12:33. doi: 10.1186/s13017-017-0144-3. eCollection 2017.
Selective non-operative management (NOM) for the treatment of blunt splenic trauma is safe. Currently, the feasibility of selective NOM for penetrating splenic injury (PSI) is unclear. Unfortunately, little is known about the success rate of spleen-preserving surgical procedures. The aim of this study was to investigate the outcome of selective NOM for penetrating splenic injuries.
A dual-centre study is performed in two level-one trauma centres. All identified patients treated for PSI were identified. Patients were grouped based on the treatment they received. Group one consisted of splenectomised patients, the second group included patients treated by a spleen-preserving surgical intervention, and group three included those patients who were treated by NOM.
A total of 118 patients with a median age of 27 and a median ISS of 25 (interquartile range (IQR) 16-34) were included. Ninety-six patients required operative intervention, of whom 45 underwent a total splenectomy and 51 underwent spleen-preserving surgical procedures. Furthermore, 22 patients (12 stab wounds and 10 gunshot wounds) were treated by NOM. There were several anticipated significant differences in the baseline encountered. The median hospitalization time was 8 (5-12) days, with no significant differences between the groups. The splenectomy group had significantly more intensive care unit (ICU) days (2(0-6) vs. 0(0-1)) and ventilation days (1(0-3) vs. 0(0-0)) compared to the NOM group. Mortality was only noted in the splenectomy group.
Spleen-preserving surgical therapy for PSI is a feasible treatment modality and is not associated with increased mortality. Moreover, a select group of patients can be treated without any surgical intervention at all.
选择性非手术治疗（NOM）用于治疗钝性脾外伤是安全的。目前，选择性 NOM 用于穿透性脾损伤（PSI）的可行性尚不清楚。不幸的是，对于保脾手术的成功率知之甚少。本研究旨在探讨选择性 NOM 治疗穿透性脾损伤的结果。
在两个一级创伤中心进行了一项双中心研究。确定了所有接受 PSI 治疗的患者。根据他们接受的治疗方法对患者进行分组。一组为脾切除术患者，第二组为保脾手术治疗患者，第三组为 NOM 治疗患者。
共纳入 118 例患者，年龄中位数为 27 岁，ISS 中位数为 25（四分位距 16-34）。96 例患者需要手术干预，其中 45 例行全脾切除术，51 例行保脾手术。此外，22 例（12 例刺伤和 10 例枪伤）接受 NOM 治疗。基线情况存在一些预期的显著差异。中位住院时间为 8（5-12）天，各组间无显著差异。与 NOM 组相比，脾切除术组 ICU 天数（2（0-6）比 0（0-1））和通气天数（1（0-3）比 0（0-0））明显更多。只有脾切除术组有死亡病例。
PSI 的保脾手术治疗是一种可行的治疗方法，不会增加死亡率。此外，还有一部分患者根本不需要手术干预。
