Van Etten E P, van Popta T, Van Luyt P A, Bode P J, Van Vugt A B
Department of General Surgery and Traumatology, Leiden University Hospital, The Netherlands.
Eur J Emerg Med. 1995 Dec;2(4):196-200. doi: 10.1097/00063110-199512000-00005.
From January 1986 to January 1995, 99 consecutive cases with a ruptured spleen were analysed retrospectively. Diagnostic peritoneal lavage was replaced by abdominal ultrasound as a routine screening investigation in blunt abdominal trauma after 1991. An abdominal computed tomography scan carried out in stable circulatory conditions provided additional information in 80% of the cases. The choice of treatment was related to the extent of the splenic damage and associated injuries. Even in degree IV ruptures splenorrhaphy was carried out successfully in 38% (five out of 12). The Hospital Trauma Index-Injury Severity Score (HTI-ISS) was significantly lower (17.7; n = 43) in conservative treatment than in cases treated by splenorrhaphy (27.6; n = 25) or splenectomy (33.6; n = 31). Conservative treatment (n = 43) resulted in a secondary intervention in 19%, whereas primary splenorrhaphy (n = 25) failed once (4%). Clinical morbidity was 26%, with no significant differences between conservative treatment, splenorrhaphy and splenectomy. Early mortality (0-30 days post-trauma) reached 14%, and was related to extensive injuries in all cases. The mean HTI-ISS in patients with a fatal outcome was 50.5. Overall, 62% of the injured spleens were saved, with the rate of splenic preservation improving throughout the study period. A conservative policy was increasingly treatment of first choice in patients with stable circulatory parameters with major concomitant injuries.
对1986年1月至1995年1月间连续收治的99例脾破裂病例进行回顾性分析。1991年以后，腹部超声取代诊断性腹腔灌洗成为钝性腹部创伤的常规筛查检查。在循环稳定的情况下进行腹部计算机断层扫描，80%的病例可提供更多信息。治疗方法的选择取决于脾损伤的程度及合并伤情况。即使在Ⅳ度破裂中，脾修补术也有38%（12例中的5例）成功实施。保守治疗组的医院创伤指数-损伤严重度评分（HTI-ISS）显著低于脾修补术组（分别为17.7；n = 43和27.6；n = 25）及脾切除术组（33.6；n = 31）。保守治疗（n = 43）导致19%的患者需要二次干预，而一期脾修补术（n = 25）失败1例（4%）。临床发病率为26%，保守治疗、脾修补术和脾切除术之间无显著差异。早期死亡率（创伤后0 - 30天）达14%，所有病例均与严重损伤有关。死亡患者的平均HTI-ISS为50.5。总体而言，62%的受损脾脏得以保留，且在整个研究期间保脾率不断提高。对于循环参数稳定且伴有严重合并伤的患者，保守治疗日益成为首选治疗方法。
