Roh Simon
Department of Interventional Radiology, St. Luke's University Hospital, Bethlehem, PA, USA.
J Trauma Inj. 2024 Dec;37(4):252-261. doi: 10.20408/jti.2024.0056. Epub 2024 Dec 16.
The management of traumatic splenic injuries has evolved significantly over the past several decades, with the majority of these injuries now being treated nonoperatively. Patients who exhibit hemodynamic instability upon initial evaluation typically require surgical intervention, while the remainder are managed conservatively. Conservative treatment for traumatic splenic injuries encompasses both medical management and splenic artery angiography, followed by embolization in cases where patients exhibit clinical signs of ongoing splenic hemorrhage. Splenic artery embolization is generally divided into two categories: proximal and distal embolization. The choice of embolization technique is determined by the severity and location of the splenic injury. Patients who retain functioning splenic tissue after trauma do not routinely need immunization. This is in contrast to post-splenectomy patients, who are at increased risk for opportunistic infections.
在过去几十年中,创伤性脾损伤的治疗方法有了显著进展,目前大多数此类损伤采用非手术治疗。初次评估时出现血流动力学不稳定的患者通常需要手术干预,其余患者则采用保守治疗。创伤性脾损伤的保守治疗包括药物治疗和脾动脉血管造影,对于出现持续性脾出血临床症状的患者,随后进行栓塞治疗。脾动脉栓塞一般分为两类:近端栓塞和远端栓塞。栓塞技术的选择取决于脾损伤的严重程度和位置。创伤后保留有功能脾组织的患者通常无需进行免疫接种。这与脾切除术后患者形成对比,后者发生机会性感染的风险增加。