Garber B G, Yelle J D, Fairfull-Smith R, Lorimer J W, Carson C
Division of General Surgery and Trauma Services, Ottawa General Hospital, Ont.
Can J Surg. 1996 Dec;39(6):474-80.
To document the current practice pattern for the treatment of splenic injuries in one Canadian trauma centre and to identify factors that determined which method was employed.
A cohort study.
A Canadian lead trauma centre.
A cohort of 100 patients with splenic injury treated at one trauma hospital over 5 years was identified from a prospective trauma database.
The success rate and failure rate for splenic salvage by splenectomy, splenorrhaphy or observation. Volume of blood transfused, injury severity score (ISS) and method of diagnosis.
The median ISS for the cohort was 34 (36 for splenectomy, 38 for splenorrhaphy and 35 for observation). A blunt mechanism of injury was present in 96%. The diagnosis was made by computed tomography (CT) in 55%. Splenic salvage was accomplished in 51 patients; of these, 44 (86%) were in the observation group, and the success rate was 90% (within the range reported in the literature). Only seven patients underwent splenorrhaphy. CT was performed more frequently in the observation group than in the splenectomy group (82% v. 25%, p < 0.0001). The splenectomy group had more blood transfused than the successful observation group (mean units 15 v. 3, p = 0.0001) and had a higher median ISS (36 v. 29, p = 0.02). Multivariate analysis revealed that the method of diagnosis (CT v. diagnostic peritoneal lavage) was the strongest factor associated with how the splenic injury was treated.
The finding in this report of an increase in observational treatment of splenic injuries represents a shift in practice from a previous Canadian report and is in keeping with recent published trends from the United States. Future studies are needed to assess whether any strong regional practice pattern variations in the management of blunt splenic injuries exists in other trauma centres across Canada.
记录加拿大一家创伤中心目前治疗脾损伤的实践模式，并确定决定采用何种治疗方法的因素。
队列研究。
加拿大一家主要创伤中心。
从一个前瞻性创伤数据库中确定了在一家创伤医院5年内接受治疗的100例脾损伤患者队列。
脾切除术、脾修补术或观察治疗脾保留的成功率和失败率。输血量、损伤严重程度评分（ISS）及诊断方法。
该队列的ISS中位数为34（脾切除术为36，脾修补术为38，观察治疗为35）。96%的损伤机制为钝性。55%的患者通过计算机断层扫描（CT）确诊。51例患者成功保留脾脏；其中44例（86%）在观察组，成功率为90%（在文献报道范围内）。仅7例患者接受了脾修补术。观察组CT检查的频率高于脾切除组（82%对25%，p<0.0001）。脾切除组的输血量多于成功观察组（平均单位15对3，p = 0.0001），且ISS中位数更高（36对29，p = 0.02）。多变量分析显示，诊断方法（CT对诊断性腹腔灌洗）是与脾损伤治疗方式相关的最强因素。
本报告中脾损伤观察治疗增加的结果代表了与加拿大先前报告相比的实践转变，并且与美国最近发表的趋势一致。需要进一步研究以评估加拿大其他创伤中心在钝性脾损伤管理方面是否存在任何强烈的区域实践模式差异。
