Hebeler R F, Ward R E, Miller P W, Ben-Menachem Y
J Trauma. 1982 Jun;22(6):492-5. doi: 10.1097/00005373-198206000-00009.
Increased concern over the potential immunologic consequences of splenectomy has prompted surgeons to attempt salvage of traumatized spleens. We report a retrospective study of 172 consecutive patients with documented splenic injury treated over a 2-year period: 107 patients underwent splenectomy; 65 were managed without total splenectomy; 32 were not explored. The overall mortality rate was 27%; the overall complications were 30%, including a 13% incidence of post-splenectomy subphrenic abscess. The incidence of infectious complications after splenectomy was 36%, while the incidence in nonsplenectomized patients was 9%. The Injury Severity Scores (ISS) in the two groups were significantly different (p less than or equal to 0.05). When the group whose spleens were salvaged was compared to an equivalent group matched for ISS, age, and sex, there was no significant difference in sepsis rates (23% vs. 10.7%; 0.10 greater than or equal to p greater than or equal to 0.05). Survival in those with postinjury infectious complications was significantly improved in patients with a remaining spleen (p less than or equal to 0.01). Abdominal computerized tomography was used successfully as a method of following injured and repaired spleens in order to predict return to full activity.
对脾切除潜在免疫后果的日益关注促使外科医生尝试挽救受创伤的脾脏。我们报告了一项对连续172例有脾损伤记录的患者进行的回顾性研究，这些患者在两年内接受治疗：107例患者接受了脾切除术；65例未进行全脾切除；32例未进行探查。总死亡率为27%；总并发症发生率为30%，包括脾切除术后膈下脓肿发生率为13%。脾切除术后感染并发症的发生率为36%，而未行脾切除患者的发生率为9%。两组的损伤严重度评分（ISS）有显著差异（p≤0.05）。当将脾脏得以挽救的组与在ISS、年龄和性别方面相匹配的同等组进行比较时，败血症发生率无显著差异（23%对10.7%；0.10≥p≥0.05）。有残留脾脏的患者在受伤后发生感染并发症时的生存率显著提高（p≤0.01）。腹部计算机断层扫描被成功用作一种跟踪受伤和修复脾脏的方法，以便预测恢复完全活动的情况。
