Clancy T V, Weintritt D C, Ramshaw D G, Churchill M P, Covington D L, Maxwell J G
Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, USA.
Am Surg. 1996 Dec;62(12):1045-9.
Recognition of the important role of the spleen within the immune system has prompted surgeons to regularly consider splenic preservation. We studied our experience at a Level II trauma center to determine whether this trend is reflected in our management. We reviewed 81 adult blunt trauma patients with splenic injury admitted between January 1988 and December 1993. We examined age, race, and clinical data including mechanism of injury, trauma and injury severity scores, organ injury scale (OIS) grade, admitting blood pressure, operations, length of stay, hospital charges, and outcome. Thirty-nine patients underwent immediate splenectomy. Nonoperative treatment was successful in 31 of 37 patients (83.7%). Mean OIS grade (American Association for the Surgery of Trauma) was significantly different between patients treated nonoperatively (1.6 +/- 0.9) and patients treated with immediate splenectomy (3.9 +/- 1.1), (P = <0.001). American Association for the Surgery of Trauma OIS grade correlated well between CT classification and classification at operation (r = 0.7, P = 0.0001) but did not predict success in nonoperative management. Hemodynamic stability, injury severity, and abdominal CT scan findings determine choice of therapy. Splenorrhaphy is frequently discussed but infrequently performed. Splenectomy remains the most commonly performed operation for splenic injury in adults with blunt splenic trauma. Nonoperative management is the most common method of splenic salvage at the Level II community hospital trauma center.
认识到脾脏在免疫系统中的重要作用促使外科医生经常考虑保留脾脏。我们研究了我们在一家二级创伤中心的经验，以确定这种趋势是否反映在我们的治疗中。我们回顾了1988年1月至1993年12月期间收治的81例成年钝性创伤性脾损伤患者。我们检查了年龄、种族和临床数据，包括损伤机制、创伤和损伤严重程度评分、器官损伤量表（OIS）分级、入院时血压、手术情况、住院时间、住院费用和治疗结果。39例患者立即接受了脾切除术。37例患者中有31例（83.7%）非手术治疗成功。非手术治疗患者与立即接受脾切除术患者的平均OIS分级（美国创伤外科协会）有显著差异（分别为1.6±0.9和3.9±1.1），（P =<0.001）。美国创伤外科协会OIS分级在CT分类和手术分类之间相关性良好（r = 0.7，P = 0.0001），但不能预测非手术治疗的成功率。血流动力学稳定性、损伤严重程度和腹部CT扫描结果决定治疗方案的选择。脾修补术经常被讨论，但很少实施。脾切除术仍然是成人钝性脾创伤性脾损伤最常实施的手术。非手术治疗是二级社区医院创伤中心最常见的脾脏挽救方法。
