Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, DK-2100, Denmark.
Department of Radiology, Division of Interventional Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Langenbecks Arch Surg. 2024 Oct 21;409(1):315. doi: 10.1007/s00423-024-03504-8.
Blunt trauma often results in splenic injuries, with non-operative management (NOM) being the preferred approach for stable patients. Following NOM, splenic vascular injuries, such as pseudoaneurysms, may arise, prompting radiological follow-up. However, a consensus on optimal radiological follow-up strategies is lacking. This systematic review evaluates existing evidence on radiological follow-up post-NOM for traumatic splenic injuries.
Conducting a systematic review following updated PRISMA guidelines, we searched MEDLINE, Embase, The Cochrane Library, and trial registries from January 2010 to March 2023. Inclusion criteria covered studies on radiological follow-up for blunt splenic injuries.
Out of 5794 studies, 17 were included involving 3392 patients. Various radiological modalities were used, with computed tomography (CT) being the most common. Vascular injuries occurred in 4.5% of patients, with most pseudoaneurysms diagnosed on day 2-6 post-trauma, and leading to intervention in 60% of these cases. Thirteen studies recommended routine follow-up, with six favouring CT, and seven supporting radiation-free modalities. Four studies proposed follow-up based on clinical indications, initial findings, or symptoms. Recommendations for specific timing of radiological follow-up ranged from 48 h to seven days post-injury. Regarding AAST grading, nine studies recommended follow-up for injury grade III and higher.
Limited high-quality evidence exists on radiological follow-up in isolated blunt splenic injuries, causing uncertainty in clinical practice. However, our review suggests a reasonable need for follow-up, with contrast-enhanced ultrasound emerging as a promising alternative to CT. Specific timing and criteria for follow-up remain unresolved, highlighting the need for high-quality prospective studies to address these knowledge gaps.
钝器伤常导致脾损伤，对于稳定型患者，非手术治疗（NOM）是首选方法。在 NOM 后，可能会出现脾血管损伤，如假性动脉瘤，需要进行影像学随访。然而，对于最佳影像学随访策略尚缺乏共识。本系统评价评估了 NOM 后创伤性脾损伤的现有影像学随访证据。
根据更新的 PRISMA 指南进行系统评价，我们检索了 MEDLINE、Embase、The Cochrane Library 和试验注册库，检索时间为 2010 年 1 月至 2023 年 3 月。纳入标准涵盖了钝性脾损伤的影像学随访研究。
在 5794 项研究中，有 17 项研究纳入了 3392 名患者。研究中使用了各种影像学方法，其中最常见的是计算机断层扫描（CT）。4.5%的患者发生血管损伤，大多数假性动脉瘤在创伤后第 2-6 天诊断，并导致其中 60%的病例需要介入治疗。13 项研究建议常规随访，其中 6 项研究支持 CT，7 项研究支持无辐射的方法。四项研究根据临床指征、初始发现或症状提出了随访建议。影像学随访的具体时间范围从损伤后 48 小时到 7 天不等。关于 AAST 分级，有 9 项研究建议对 III 级及以上损伤进行随访。
孤立性钝性脾损伤的影像学随访证据有限且质量不高，导致临床实践存在不确定性。然而，本综述表明，随访具有一定的必要性，增强超声可能是 CT 的一种有前途的替代方法。具体的随访时间和标准仍未解决，这突出表明需要进行高质量的前瞻性研究来解决这些知识空白。
