非洲本地人的脾脏损伤：在尼日利亚东南部的一个平民创伤服务中呈现、治疗局限性和治疗结果。
Splenic injuries in native Africans: Presentation, limitations of management, and treatment outcomes in a civilian trauma service in Southeast Nigeria.
机构信息
Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State; Department of Surgery, Bishop Shanahan Specialist Hospital, Nsukka, Enugu State; Department of Surgery, Mater Misericordie Hospital, Afikpo, Ebonyi State; Department of Surgery, Ebonyi State University, Abakaliki, Nigeria.
Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State; Department of Surgery, Ebonyi State University, Abakaliki, Nigeria.
出版信息
Ann Afr Med. 2022 Oct-Dec;21(4):327-338. doi: 10.4103/aam.aam_53_21.
BACKGROUND
Splenic trauma has emerged as a major global health burden, especially in developing nations with limited diagnostic and therapeutic facilities. The current trend toward nonoperative management (NOM) and adoption of splenic salvage whenever feasible calls for local evaluation of our current practice. The aim of this study was to document the epidemiology and outcomes of management of splenic injuries in our setting.
PATIENTS AND METHODS
This was a multicenter, prospective study of epidemiology and outcomes of patients with splenic injuries recruited over 10 years in southeast Nigeria.
RESULTS
Approximately 66% of all patients with abdominal injuries sustained splenic trauma. A total of 313 patients with splenic trauma were recruited; 226 (72.2%) were managed operatively (OM) and 87 (27.8%) conservatively (NOM). Majority (75.7%) had blunt abdominal trauma (BAT), while 24.3% sustained penetrating injuries. Sonographic grading showed that 46 (14.7%), 58 (18.5%), 79 (25.2%), 106 (33.9%), and 24 (7.7%) patients had grades I, II, III, IV, and V injuries, respectively. Isolated splenic injuries occurred in 172 (55%) patients, and the rest (141, 45%) had associated intra-abdominal injuries. Two-thirds (67.1%) were aged 16-45 years. In the OM group, 178 (78.7%) had total splenectomy, while 48 (21.3%) had splenic salvage. There was a statistically significant difference (P = 0.022) in the rate of postoperative complications between the splenectomy and splenorrhaphy groups. The overall mortality rate was 4.5%. Major predictors of morbidity and mortality were high-grade splenic injuries, total splenectomy, multiple injuries, advanced age, and comorbidities.
CONCLUSION
Splenic injuries complicate approximately two-thirds of all abdominal injuries in our environment and majority of these injuries were due to BAT. In this study, majority had OM and splenic salvage rate was relatively low.
背景
脾脏创伤已成为全球范围内的一个主要健康负担，尤其是在诊断和治疗设施有限的发展中国家。目前，非手术治疗（NOM）和尽可能保留脾脏的趋势要求对我们目前的实践进行局部评估。本研究旨在记录我们环境中脾脏损伤管理的流行病学和结果。
患者和方法
这是一项在尼日利亚东南部进行的 10 年多的多中心、前瞻性研究，研究对象为腹部损伤患者的流行病学和结局。
结果
所有腹部损伤患者中，约有 66%合并脾脏创伤。共招募了 313 例脾脏创伤患者；226 例（72.2%）接受了手术治疗（OM），87 例（27.8%）接受了保守治疗（NOM）。大多数（75.7%）患者有钝性腹部创伤（BAT），而 24.3%的患者有穿透性损伤。超声分级显示，46 例（14.7%）、58 例（18.5%）、79 例（25.2%）、106 例（33.9%）和 24 例（7.7%）患者的损伤程度分别为 I、II、III、IV 和 V 级。172 例（55%）患者为单纯性脾脏损伤，其余 141 例（45%）患者合并有腹腔内其他损伤。67.1%的患者年龄在 16-45 岁之间。在 OM 组中，178 例（78.7%）患者行全脾切除术，48 例（21.3%）患者行脾修补术。脾切除术组和脾修补术组术后并发症发生率存在统计学差异（P = 0.022）。总死亡率为 4.5%。发病率和死亡率的主要预测因素为高级别脾损伤、全脾切除术、多发伤、高龄和合并症。
结论
在我们的环境中，脾脏损伤约占所有腹部损伤的三分之二，其中大多数损伤是由于 BAT 引起的。在这项研究中，大多数患者接受了 OM 治疗，且保留脾脏的比例相对较低。
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