Lee Rang, Jeon Chang Ho, Kim Chang Won, Kwon Hoon, Kim Jae Hun, Kim Hohyun, Park Sung Jin, Kim Gil Hwan, Park Chan Yong
Department of Radiology, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Republic of Korea.
Department of Radiology, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Republic of Korea.
J Vasc Interv Radiol. 2020 Oct;31(10):1570-1577.e2. doi: 10.1016/j.jvir.2020.01.029. Epub 2020 Apr 25.
To evaluate the benefits and risks of splenic artery embolization (SAE) in patients with American Association for the Surgery of Trauma (AAST) grade V blunt spleen injury (BSI) MATERIALS AND METHODS: Medical records of 88 patients treated with SAE between April 2013 and May 2017 at a regional trauma care center were reviewed retrospectively. The BSI grade according to the AAST spleen injury scale (revised version 2018) was determined by using computed tomography (CT) images. A total of 42 patients (46.6%) had AAST grade V injury and were included in the analysis. Patient demographics, angiographic findings, embolization techniques, and technical and clinical outcomes, including splenic salvage rate and procedure-related complications, were examined.
SAE was performed within 2 hours after admission for 78.5% of the patients. All patients underwent selective distal embolization (n = 42). Primary clinical success rate was 80.9% (n = 34), and secondary clinical success rate was 88.1% (n = 37). The clinical failure group consisted of 5 patients. Four patients underwent splenectomy, and 1 patient died due to acute respiratory distress syndrome after embolization. The splenic salvage rate was 85.7% (n = 36). No patient had sepsis at follow-up (median, 247.0 days; interquartile range, 92.0-688.0). Clinical success rates (P = .356) and spleen salvage rates (P = .197) of patients who were hemodynamically stable (n = 19) showed no significant differences from those who were unstable (n = 23).
Distal embolization of grade V BSI is a safe and feasible procedure which is effective for successful spleen salvage.
评估美国创伤外科学会（AAST）V级钝性脾损伤（BSI）患者行脾动脉栓塞术（SAE）的获益与风险。材料与方法：回顾性分析2013年4月至2017年5月间在某区域创伤护理中心接受SAE治疗的88例患者的病历。根据AAST脾损伤分级标准（2018年修订版），利用计算机断层扫描（CT）图像确定BSI分级。共有42例（46.6%）患者为AAST V级损伤并纳入分析。检查患者的人口统计学资料、血管造影结果、栓塞技术以及技术和临床结局，包括脾脏挽救率和与手术相关的并发症。
78.5%的患者在入院后2小时内接受了SAE。所有患者均接受了选择性远端栓塞（n = 42）。主要临床成功率为80.9%（n = 34），次要临床成功率为88.1%（n = 37）。临床失败组有5例患者。4例患者接受了脾切除术，1例患者在栓塞后因急性呼吸窘迫综合征死亡。脾脏挽救率为85.7%（n = 36）。随访期间（中位时间247.0天；四分位间距92.0 - 688.0）无患者发生败血症。血流动力学稳定患者（n = 19）的临床成功率（P = 0.356）和脾脏挽救率（P = 0.197）与不稳定患者（n = 23）相比无显著差异。
V级BSI的远端栓塞是一种安全可行的手术，对成功挽救脾脏有效。
