Department of Surgery, 12325University of Tennessee Health Science Campus, Memphis, TN, USA.
Department of Surgery, 3989Baylor College of Medicine, Houston, TX, USA.
Am Surg. 2022 Jul;88(7):1504-1509. doi: 10.1177/00031348221082285. Epub 2022 Mar 28.
The role of serial computed tomography (CT) in the nonoperative management of blunt splenic injuries (NOMSIs) remains unclear. The purpose of the study was to determine the utility of serial CT of Grade 2-5 NOMSI in the modern era.
Blunt splenic injuries were identified over a 3.5-year period, ending in 6/2020. Our institutional protocol for NOMSI mandates a repeat 24-hour CT for Grade 2-5 injuries. Patients age<18, Grade 1 injuries and patients that underwent intervention prior to repeat scan were excluded. Demographics, comorbidities, timing of events (admission, CTs, splenectomy, and angiography), injury details, procedural details, total transfusion requirements, complications, length of stay, mortality, and discharge disposition were recorded. Descriptive statistics were performed.
219 patients with Grade 2-5 NOMSI had both an initial and 24-hour CT after exclusions. 24-hour CT identified 14 patients with new PSA(s) and 11 (5%) went to angiography within 24 hours with 9 (4%) undergoing angioembolization and 4 (2%) had splenectomy. Two hundred and four (93%) had no intervention though eventually 12 went on to angiography and 6 went for splenectomy. The 24-hour CT rarely altered management in the absence of clinical indication or prior PSA on initial CT with 5 (2%) receiving a therapeutic embolization and 2 (1%) had a nontherapeutic angiogram. No deaths were attributable to splenic injury.
Routine 24-hour CT for NOMSI did not impact management. Clinical status and change in exam may warrant repeat CT in select cases in the setting of a plausible alternate explanation. Prompt angioembolization or splenectomy is more appropriate in clear-cut cases of failed NOMSI.
在非手术治疗钝性脾损伤（NOMSI）中，连续计算机断层扫描（CT）的作用仍不清楚。本研究的目的是确定在现代，对 2-5 级 NOMSI 进行连续 CT 的效用。
在 3.5 年期间确定了钝性脾损伤，截止到 2020 年 6 月。我们机构对 NOMSI 的治疗方案规定，对于 2-5 级损伤，需进行 24 小时的重复 CT。排除年龄<18 岁、1 级损伤和在重复扫描前进行介入治疗的患者。记录患者的人口统计学、合并症、事件时间（入院、CT、脾切除术和血管造影）、损伤细节、程序细节、总输血需求、并发症、住院时间、死亡率和出院情况。进行描述性统计分析。
排除后，219 例 2-5 级 NOMSI 患者均进行了初始 CT 和 24 小时 CT。24 小时 CT 发现 14 例患者有新的 PSA（s），11 例（5%）在 24 小时内行血管造影，其中 9 例（4%）行血管栓塞，4 例（2%）行脾切除术。尽管最终有 12 例进行了血管造影，6 例进行了脾切除术，但 204 例（93%）患者未进行干预。24 小时 CT 在没有临床指征或初始 CT 已有 PSA 的情况下，很少改变治疗方案，有 5 例（2%）患者接受了治疗性栓塞，2 例（1%）患者进行了非治疗性血管造影。没有因脾损伤导致的死亡。
NOMSI 的常规 24 小时 CT 检查并未影响治疗。在合理的替代解释情况下，临床状况和检查变化可能需要在特定情况下重复 CT。在明确的 NOMSI 治疗失败病例中，快速血管栓塞或脾切除术更为合适。
