Mitsusada Makoto, Nakajima Yasushi
Department of Emergency Medicine Tokyo Metropolitan Hiroo General Hospital Tokyo Japan.
Acute Med Surg. 2014 Apr 23;1(4):200-206. doi: 10.1002/ams2.37. eCollection 2014 Oct.
The increased prevalence of non-operative management of splenic injuries contributes to the infrequent use of salvage procedures. Nevertheless, salvage procedures are sometimes required. The study aimed to evaluate the safety and feasibility of our salvage procedure protocol for selected patients.
This retrospective study included 27 splenic injury patients divided into two groups: those treated by salvage procedures (splenorrhaphy or partial resection) and those who underwent splenectomy. Our salvage procedure protocol was applied in the following situations: if hemodynamics were stable during laparotomy or bleeding was fully controlled by manual or incisional mobilization of the organ, when no more than two other organs required repair, and if no clinical coagulopathy existed.
The splenic abbreviated injury scale, intraoperative bleeding, and transfusion requirements of packed red blood cells and fresh frozen plasma requirements in 24 h were significantly lower in the salvage procedure group. There was no difference in the injury severity score, initial amount of bleeding, length of intensive care unit stay, or morbidity and mortality rates between the groups. Patients who underwent salvage procedures were managed without major complication, except one pseudoaneurysm case.
We confirmed the feasibility of our salvage procedure protocol for selected patients, particularly for those with simple or lower grade injuries.
脾损伤非手术治疗的患病率增加导致挽救性手术的使用频率降低。然而，有时仍需要进行挽救性手术。本研究旨在评估我们为特定患者制定的挽救性手术方案的安全性和可行性。
这项回顾性研究纳入了27例脾损伤患者，分为两组：接受挽救性手术（脾修补术或部分切除术）的患者和接受脾切除术的患者。我们的挽救性手术方案适用于以下情况：剖腹手术期间血流动力学稳定，或通过手动或切开器官移动完全控制出血，其他需要修复的器官不超过两个，且不存在临床凝血功能障碍。
挽救性手术组的脾简化损伤评分、术中出血量、24小时内红细胞悬液和新鲜冰冻血浆的输注需求量显著更低。两组之间的损伤严重程度评分、初始出血量、重症监护病房住院时间或发病率和死亡率没有差异。接受挽救性手术的患者除1例假性动脉瘤病例外，均未出现重大并发症。
我们证实了我们为特定患者制定的挽救性手术方案的可行性，特别是对于那些损伤简单或程度较低的患者。
