1 Department of Diagnostic Imaging, The Ottawa Hospital, University of Ottawa, 501 Smyth Rd, Ottawa, ON K1H 8L6, Canada.
2 The Ottawa Hospital Research Institute and Method Center, Ottawa, ON, Canada.
AJR Am J Roentgenol. 2017 Dec;209(6):W382-W387. doi: 10.2214/AJR.17.18005. Epub 2017 Sep 20.
The purpose of this study was to compare the efficacy of gelatin sponge with that of coils for splenic artery embolization in the treatment of blunt splenic injury.
A single-center retrospective review was performed with the records of 63 patients (45 men, 18 women; mean age, 45.5 years; range, 16-84 years) with blunt splenic injury treated at a tertiary care trauma center by splenic artery embolization with gelatin sponge (n = 30 patients) or metallic coils (n = 33 patients) between 2005 and 2014. The two groups had comparable median American Association for the Surgery of Trauma grades of IV and comparable angiographic appearances regarding active extravasation and pseudoaneurysm formation at preembolization splenic arteriography (p = 0.32). Clinical outcomes and procedure-related outcomes were evaluated.
The success rates were similar in the two groups: splenic artery embolization failed in 6.6% (2/30) of patients in the gelatin sponge group and 12.1% (4/33) in the coil embolization group (p = 0.45; 95% CI, -30.1% to 19.2%). Major complications occurred in six patients (20.0%) in the gelatin sponge group and in six patients (18.1%) in the coil group (p = 0.85; 95% CI, -23.0% to 26.6%). Minor complications occurred in three patients (10.0%) in the gelatin sponge group and seven patients (21.2%) in the coil group (p = 0.21; 95% CI, -35.4% to 14.0%). Procedure time was significantly shorter in the gelatin sponge group (median, 32 minutes; interquartile range, 18-48 minutes) than in the coil group (median, 53 minutes; interquartile range, 30-76 minutes) (p = 0.01).
Splenic artery embolization with gelatin sponge appears to be as effective and as safe as coil embolization and can be completed in a shorter time.
本研究旨在比较明胶海绵与线圈用于脾动脉栓塞治疗钝性脾损伤的疗效。
对 2005 年至 2014 年间在一家三级创伤中心接受脾动脉栓塞治疗的 63 例（45 例男性，18 例女性；平均年龄 45.5 岁；年龄范围 16-84 岁）患者的记录进行了单中心回顾性分析，这些患者分别使用明胶海绵（n = 30 例）或金属线圈（n = 33 例）进行脾动脉栓塞。两组患者的美国创伤外科协会（AAST）分级中位数均为 IV 级，且脾动脉栓塞前造影显示活动性外渗和假性动脉瘤形成的血管造影表现相似（p = 0.32）。评估了临床结局和与操作相关的结局。
两组的成功率相似：明胶海绵组有 6.6%（2/30 例）的患者脾动脉栓塞失败，线圈栓塞组有 12.1%（4/33 例）的患者脾动脉栓塞失败（p = 0.45；95%CI，-30.1%至 19.2%）。明胶海绵组有 6 例（20.0%）患者发生重大并发症，线圈组有 6 例（18.1%）患者发生重大并发症（p = 0.85；95%CI，-23.0%至 26.6%）。明胶海绵组有 3 例（10.0%）患者发生轻微并发症，线圈组有 7 例（21.2%）患者发生轻微并发症（p = 0.21；95%CI，-35.4%至 14.0%）。明胶海绵组的操作时间明显短于线圈组（中位数 32 分钟；四分位距 18-48 分钟）（p = 0.01）。
明胶海绵脾动脉栓塞与线圈栓塞一样有效且安全，并能在更短的时间内完成。
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