Moreno Peter, Von Allmen Matthias, Haltmeier Tobias, Candinas Daniel, Schnüriger Beat
Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
World J Surg. 2018 May;42(5):1358-1363. doi: 10.1007/s00268-017-4336-5.
Non-operative management (NOM) of blunt splenic or liver injuries (solid organ injury, SOI) has become the standard of care in hemodynamically stable patients. However, the incidence of long-term symptoms in these patients is currently not known. The aim of this study was to assess long-term symptoms in patients undergoing successful NOM (sNOM) for SOI.
Long-term posttraumatic outcomes including chronic abdominal pain, irregular bowel movements, and recurrent infections were assessed using a specifically designed questionnaire and analyzed by univariable analysis.
Eighty out of 138 (58%) patients with SOI undergoing sNOM) responded to the questionnaire. Median (IQR) follow-up time was 48.8 (28) months. Twenty-seven (34%) patients complained of at least one of the following symptoms: 17 (53%) chronic abdominal pain, 13 (41%) irregular bowel movements, and 8 (25%) recurrent infections. One female patient reported secondary infertility. No significant association between the above-mentioned symptoms and the Injury Severity Score, amount of hemoperitoneum, or high-grade SOI was found. Patients with chronic pain were significantly younger than asymptomatic patients (32.1 ± 14.5 vs. 48.3 ± 19.4 years, p = 0.002). Irregular bowel movements were significantly more frequent in patients with severe pelvic fractures (15.4 vs. 0.0%, p = 0.025). A trend toward a higher frequency of recurrent infections was found in patients with splenic injuries (15.9 vs. 2.8%, p = 0.067).
A third of patients with blunt SOI undergoing sNOM reported long-term abdominal symptoms. Younger age was associated with chronic abdominal symptoms. More studies are warranted to investigate long-term outcomes immunologic sequelae in patients after sNOM for SOI.
钝性脾或肝损伤（实体器官损伤，SOI）的非手术治疗（NOM）已成为血流动力学稳定患者的标准治疗方法。然而，目前尚不清楚这些患者长期症状的发生率。本研究的目的是评估因SOI接受成功非手术治疗（sNOM）的患者的长期症状。
使用专门设计的问卷评估长期创伤后结局，包括慢性腹痛、排便习惯改变和反复感染，并进行单变量分析。
138例接受sNOM的SOI患者中有80例（58%）回复了问卷。中位（IQR）随访时间为48.8（28）个月。27例（34%）患者抱怨至少出现以下一种症状：17例（53%）慢性腹痛，13例（41%）排便习惯改变，8例（25%）反复感染。一名女性患者报告继发性不孕。未发现上述症状与损伤严重程度评分、腹腔积血量或高级别SOI之间存在显著关联。慢性疼痛患者明显比无症状患者年轻（32.1±14.5岁对48.3±19.4岁，p=0.002）。严重骨盆骨折患者排便习惯改变明显更频繁（15.4%对0.0%，p=0.025）。脾损伤患者反复感染频率有升高趋势（15.9%对2.8%，p=0.067）。
接受sNOM的钝性SOI患者中有三分之一报告有长期腹部症状。年龄较小与慢性腹部症状有关。有必要进行更多研究以调查SOI患者接受sNOM后的长期结局和免疫后遗症。
