钝性脾损伤：影响非手术治疗失败率的预测因素和危险因素分析。
Blunt splenic trauma: Analysis of predictors and risk factors affecting the non-operative management failure rate.
机构信息
Department of General Surgery, Health Sciences University Ümraniye Training and Research Hospital, İstanbul-Türkiye.
Department of General Surgery, Tokat State Hospital, Tokat-Türkiye.
出版信息
Ulus Travma Acil Cerrahi Derg. 2022 Oct;28(10):1428-1436. doi: 10.14744/tjtes.2022.95476.
BACKGROUND
Non-operative management (NOM) has become a standard treatment in hemodynamically stable patients with blunt splenic trauma. Studies have identified numerous predictors and risk factors for NOM. However, these factors' role in NOM failure continues to be debated. This study aimed to reveal the role of these factors in NOM failure through retrospective analysis of data from patients who underwent non-operative treatment.
METHODS
After the initial evaluation of 189 patients brought to the emergency department between March 2009 and June 2021 and diagnosed with blunt splenic trauma, 13 patients underwent emergency surgery due to hemodynamic instability (immediate splenectomy), and 18 patients who died were excluded from the study. NOM was planned for the remaining 158 patients (stable or stabilized). Patients scheduled for NOM were grouped as either successful NOM (s-NOM; n=139) or failure NOM (f-NOM; n=19) and analyzed the results, retrospectively.
RESULTS
Of the 158 patients scheduled for the NOM, 115 were male. The mean age in s-NOM and f-NOM was 32.2±14.5 versus 36.1±16.1. The mean hospital stay was 8 (4-21) days. The mean follow-up period was 12 (6-18) months. Used USG for 60 (43.2%) patients and CT for 137 (98.6%) in the NOM. The number of Grades I-V in the NOM planned patients (n=158) was 20 (12.6%), 54 (34.1%) 56 (35.4%), 26 (16.4%), and 2 (1.3%), respectively. The success rates according to the Grades I-V were 20 (100%), 52 (96.3%), 52 (92.8%), 15 (57.7%), and 0 (0.0%), respectively. There were 102 units of red cell transfusions administered (mean, 2.46 units) to 41 patients in the s-NOM group, while 81 units (mean, 4.26 units) were administered to 19 patients in the f-NOM group (p=0.001). ISS score >15 was 57.5% (mean score, 22.8) and those in the f-NOM group were 78.9% (mean score, 34.8), respectively (p<0.001). Overall NOM success was 88.0%, total complications were 10.1%, and mortality was 1.2% in this study.
CONCLUSION
Grades I-III blunt splenic trauma patients were successfully treated using the NOM protocol in this study. However, more than half of Grade IV (57.7%) splenic injuries were successfully treated using NOM. Identifying predictors and risk factors based on a standardized plan will likely increase this success.
背景
非手术治疗（NOM）已成为血流动力学稳定的钝性脾外伤患者的标准治疗方法。有研究确定了许多 NOM 的预测因子和危险因素。然而，这些因素在 NOM 失败中的作用仍存在争议。本研究旨在通过对接受非手术治疗的患者数据进行回顾性分析，揭示这些因素在 NOM 失败中的作用。
方法
对 2009 年 3 月至 2021 年 6 月期间因钝性脾外伤被送至急诊科并初步评估的 189 例患者进行评估后，13 例患者因血流动力学不稳定（立即脾切除术）而行急诊手术，18 例死亡患者被排除在研究之外。其余 158 例患者（稳定或稳定）计划进行 NOM。计划接受 NOM 的患者被分为成功 NOM（s-NOM；n=139）或失败 NOM（f-NOM；n=19），并进行回顾性分析结果。
结果
在计划接受 NOM 的 158 例患者中，115 例为男性。s-NOM 和 f-NOM 的平均年龄分别为 32.2±14.5 岁和 36.1±16.1 岁。平均住院时间为 8（4-21）天。平均随访时间为 12（6-18）个月。60（43.2%）例患者接受了 USG，137（98.6%）例患者接受了 CT 检查。NOM 计划患者（n=158）的分级 I-V 例数分别为 20（12.6%）、54（34.1%）、56（35.4%）、26（16.4%）和 2（1.3%）。根据分级 I-V 的成功率分别为 20（100%）、52（96.3%）、52（92.8%）、15（57.7%）和 0（0.0%）。s-NOM 组 41 例患者输注了 102 单位红细胞（平均 2.46 单位），而 f-NOM 组 19 例患者输注了 81 单位（平均 4.26 单位）（p=0.001）。s-NOM 组 ISS 评分>15 占 57.5%（平均评分 22.8），f-NOM 组占 78.9%（平均评分 34.8）（p<0.001）。本研究中 NOM 总成功率为 88.0%，总并发症发生率为 10.1%，死亡率为 1.2%。
结论
本研究中，使用 NOM 方案成功治疗了 I-III 级钝性脾外伤患者。然而，超过一半的 IV 级（57.7%）脾损伤也成功地使用 NOM 进行了治疗。基于标准化方案识别预测因子和危险因素可能会增加这种成功率。
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