成人钝性脾损伤的非手术治疗  

A study on the nonoperafive treatment of adult blunt splenic injuries

作　　者：谢方亮[1] 李伟[1] 葛夏青[1] 刘胜利[1] 葛旭明[1] 

机构地区：[1]徐州医学院附属连云港医院肝胆外科,江苏省221012

出　　处：《中华普通外科杂志》2015年第7期538-540,共3页Chinese Journal of General Surgery

摘　　要：目的探讨成人钝性脾损伤的非手术治疗方法，以提高非手术治疗成功率。方法回顾性分析2010年3月至2014年10月收治的141例患者临床资料，依据2000年中华外科学分会脾脏外科学组推出“脾脏损伤程度分级”标准，按伤后6h内的治疗方案，分为手术治疗和非手术治疗。结果非手术比例达69．5％（98／141），成功率达89．8％（88／98）。手术治疗43例：Ⅲ级34例、Ⅳ级9例，死亡3例。非手术治疗98例：Ⅰ级32例、Ⅱ级50例、Ⅲ级15例、Ⅳ级1例。非手术治疗失败10例，包括：Ⅰ级1例，因合并胰腺及小肠损伤，观察期间出现腹膜炎体征而中转手术；Ⅱ级1例，合并肝挫伤等损伤，保守治疗3d后出现肺部并发症、剧烈咳嗽导致再出血而中转手术；Ⅲ级7例，多因肺部并发症导致再出血而中转手术；Ⅳ级1例，合并多器官损伤，入院检查过程中出现休克后急诊手术。非手术治疗死亡2例：Ⅲ级1例、Ⅳ级1例。结论选择性非手术治疗Ⅱ级及以下钝性脾损伤是一种安全有效的治疗手段。Objective To increase curative rate of nonoperation treatment for adult blunt splenic trauma. Methods Data of 141 patients with blunt splenic trauma treated in our hospital from March 2010 to October 2014 were retrospectively analyzed in accordance with the spleen injury degree classification issued by the Spleen Surgery Group of Chinese Society of Surgery in 2000. According to the treatment within 6 hours of injury, these patients were divided into operative and nonoperative management groups. Results The proportion of non operation was 69. 5% （98/141） and the success rate was 89. 8% （88/98）. 43 cases were in operation group ： 34 cases in grade Ⅲ, 9 cases with grade Ⅳ, 3 cases died; 98 cases were in non operation group： including 32 cases of grade Ⅰ , 50 eases of grade Ⅱ,15 cases of grade Ⅲ, 1 case with grade Ⅳ. 10 cases failed non operation treatment including 1 case with grade Ⅰ complicated by pancreatic and intestinal injury causing peritonitis during the period of observation, 1 ease of grade Ⅱ complicated by contusion of the liver and secondary bleeding on day 3 after the trauma, 7 cases of grade Ⅲ, were converted to surgery because of multiple organ injury and rebleeding secondary to pulmonary complications, and 1 case of grade Ⅳ with multiple organ injury and shock being immediately converted to surgery. In overall there were 2 deaths in nonsurgery group, 1 case with grade Ⅲ and 1 case with grade Ⅳ. Conclusions Nonoperative treatment of blunt splenic trauma is safe and feasible in grade up to Ⅱ blund splenic trauma patients.

关 键 词：脾 创伤和损伤 非手术治疗 

分 类 号：R657.62[医药卫生—外科学]