Department of Trauma, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
Department of Trauma, University Hospital Zurich, Zurich, Switzerland.
Eur J Trauma Emerg Surg. 2019 Dec;45(6):979-985. doi: 10.1007/s00068-019-01117-1. Epub 2019 Apr 10.
The treatment of abdominal solid organ injuries has shifted towards non-operative management (NOM). However, the feasibility of NOM for penetrating splenic trauma is unclear and outcome is believed to be worse than NOM for penetrating liver and kidney injuries. Hence, the aim of the current systematic review was to evaluate the feasibility of selective NOM in penetrating splenic injury.
A review of literature was performed using Pubmed, Embase and Cochrane databases. Studies on adult patients treated by NOM for splenic injuries were included and outcome was documented and compared.
Five articles from exclusively level-1 and level-2-traumacenters were selected and a total of 608 cases of penetrating splenic injury were included. Nonoperative management was applied in 123 patients (20.4%, range 17-33%). An overall failure rate of NOM of 18% was calculated. Mortality was not seen in patients selected for nonoperative management. Contra-indicatons for NOM included hemodynamic instability, absence of abdominal CT-scanning to rule out concurrent injuries and peritonitis.
This review demonstrates that non-operative management for penetrating splenic trauma in highly selected patients has been utilized in several well-equipped and experienced trauma centers. NOM of penetrating splenic injury in selected patients is not associated with increased morbidity nor mortality. Data on the less well-equipped and experienced trauma centers are not available. More prospective studies are required to further define exact selection criteria for non-operative management in splenic trauma.
腹部实质脏器损伤的治疗已转向非手术治疗（NOM）。然而，穿透性脾损伤行 NOM 的可行性尚不清楚，且据信其结果比穿透性肝、肾损伤行 NOM 的结果更差。因此，目前系统评价的目的是评估选择性 NOM 在穿透性脾损伤中的可行性。
使用 Pubmed、Embase 和 Cochrane 数据库进行文献复习。纳入接受 NOM 治疗的成人脾损伤患者的研究，并记录和比较结果。
选择了 5 篇来自专门的 1 级和 2 级创伤中心的文章，共纳入 608 例穿透性脾损伤患者。123 例（20.4%，范围 17-33%）患者采用非手术治疗。NOM 的总体失败率为 18%。选择非手术治疗的患者未发生死亡率。NOM 的禁忌症包括血流动力学不稳定、缺乏排除并发损伤和腹膜炎的腹部 CT 扫描。
本综述表明，在一些设备齐全、经验丰富的创伤中心，对高度选择的穿透性脾损伤患者采用非手术治疗。在选择的患者中，穿透性脾损伤的 NOM 不会增加发病率或死亡率。关于设备较差和经验较少的创伤中心的数据尚不可用。需要更多的前瞻性研究来进一步确定脾外伤 NOM 的具体选择标准。
