Nonoperative management of splenic injuries: Improved results with angioembolization
Nonoperative management of splenic injuries: Improved results with angioembolization
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DOI：
10.1097/01.ta.0000223466.62589.d9
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发表时间：
2006-07-01
影响因子：
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通讯作者：
Naess, Paal Aksel
中科院分区：
文献类型：
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作者：
Gaarder, Christine;Dormagen, Johann Baptist;Naess, Paal Aksel
背景：严重脾损伤患者的非手术治疗(NOM)具有显著的失败风险。我们假设在NOM方案的基础上加用血管造影栓塞术(AE)可以降低开腹手术的成功率，提高NOM的成功率和脾的保留率。实施了一项在脾损伤治疗中引入AE的方案。对于3到5级的OIS脾损伤以及无论损伤级别如何均有持续出血迹象的所有病例，均进行了动脉栓塞治疗。结果：组1(AE前)69例，平均损伤严重度评分(ISS)31分；组2(引入AE后)，组，平均ISS 30分。组1即刻开腹30例(43%)，手术成功率79%。术后即刻开腹17例(27%；P=0.04)，手术成功率96%(P=0.02)。脾总保留率从57%提高到75%(p=0.02)。第2组31例行血管造影，其中27例行血管栓塞术。声发射失败率为4%。在15例OIS损伤4级和5级的患者中，有14例在引入AE后获得NOM成功(93%)。结论：对于严重的脾损伤，在NOM中加入强制的AE可以提高尝试NOM的患者的比例、NOM成功率和脾挽救率。
Background: Nonoperative management (NOM) of patients with severe splenic injuries carries a significant risk of failure. We hypothesized that adding angiographic embolization (AE) to the NOM protocol would decrease the laparotomy rate, and increase the success rate of NOM and splenic salvage rate.Methods. A protocol introducing AE in the treatment of splenic injuries was implemented. AE was performed in OIS splenic injury grades 3 to 5 and in all cases where signs of ongoing bleeding were encountered regardless of injury grade. Patients included in a prospective study during a 24-month period were compared with a historic control group.Results: Group 1 (before AE) consisted of 69 patients with a mean Injury Severity Score (ISS) of 31, and group 2 (after introducing AE) included 64 patients with a mean ISS of 30. In group 1, 30 patients underwent immediate laparotomy (43%), and the NOM success rate was 79%. After introducing AE, 17 patients underwent immediate laparotomy (27%; p = 0.04), with a NOM success rate of 96% (p = 0.02). Overall splenic salvage rate increased from 57% to 75% (p = 0.02). Angiography was performed in 31 patients in group 2. Embolization was performed in 27 of these patients. AE failure rate was 4%. NOM was successful in 14 of 15 patients with OIS injury grades 4 and 5 after the introduction of AE (93%).Conclusion: A formal protocol adding mandatory AE to NOM for severe splenic injuries increased the percentage of patients in whom NOM was attempted, the NOM success rate, and the splenic salvage rate.