钝性脾损伤非手术治疗探讨

目的 探讨钝性脾损伤非手术治疗的监测和治疗方法.方法 回顾分析2005年9月至2008年4月连续收治的95例钝性脾损伤患者中行非手术治疗的82例(86.3%)患者的临床资料.其中75例应用经皮腹腔穿刺置管引流、监测腹腔出血,38例行非术中自体血回输.全部病例随访3周～8个月.结果 82例非手术治疗全部成功,其中Ⅲ～Ⅳ级钝性脾损伤34例、55岁以上者6例、损伤严重度评分≥16分者14例.37例腹腔出血量500 ml,引流腹腔血量30～2400 ml.38例回输自体血量共23 300 ml,平均613 ml.随访除脾介入术后并发脾假性囊肿1例外,无延迟出血、腹腔感染等并发症发生.结论 大多数血流动力学稳定的钝性脾损伤可通过非手术治疗治愈.运用经皮腹腔穿刺置管引流回收并监测腹腔出血及非术中自体血回输技术,可明显提高钝性脾损伤的非手术治疗率和成功率.

Nonoperative management of blunt splenic injury

Objective To investigate the monitoring and therapeutic methods of nonoperative management of blunt splenic injury. Methods Eighty-two cases with nonoperative management of 95 patients of blunt splenic injury from September 2005 to April 2008 were analyzed retrospectively. Percutaneous peritoneal drainage was applied to 75 cases, and autoblood transfusion was applied to 38 cases. Eighty-two cases were followed up from 3 weeks to 8 months. Results Eighty-two patients with nonoperative management were treated successfully,including 34 cases classified as grade Ⅲ to Ⅳ ,6 cases over 55 years old, 14 cases with severe multiple injury (ISS ≥ 16) and 37 cases whose drained peritoneal blood volume were over 500 ml. The drained peritoneal blood volume was 30 to 2400 ml. The total volume of autoblood transfusion was 22 300 ml and the average volume was 613 ml. All cases were followed up without delayed hematocelia or peritoneal infection. Conclusions Most hemedynamically stable patients with blunt splenic injury can be healed with nonoperative management. The treatments including pereutaneous peritoneal drainage and transfusion of autoblood can significantly increase the performance rate and the achievement ratio of nonoperative management of blunt splenic injury.