外伤性脾破裂三阶梯分层治疗策略  

Three-step stratified treatment strategy for traumatic splenic rupture

作　　者：张腾花 尚培中 王晓梅 李晓武 王金 苗建军 刘冰 Zhang Tenghua;Shang Peizhong;Wang Xiaomei;Li Xiaowu;Wang Jin;Miao Jianjun;Liu Bing(Department of Critical Care Medicine,the 81st Group Army Hospital of PLA,Zhangjiakou Hebei Province 075000,China;Department of General Surgery,the 81st Group Army Hospital of PLA,Zhangjiakou Hebei Province 075000,China)

机构地区：[1]陆军第八十一集团军医院重症医学科,河北张家口075000 [2]陆军第八十一集团军医院普通外科,河北张家口075000

出　　处：《中华普外科手术学杂志（电子版）》2024年第5期510-512,共3页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：张家口市卫生健康和生物医疗专项重点研发计划项目(2322142D)。

摘　　要：目的:探讨外伤性脾破裂(TSR)三阶梯分层治疗策略对提高患者无创及微创治愈率的临床意义。方法:回顾分析2013年7月至2022年9月107例非手术治疗和182例手术治疗的TSR患者临床资料,分析非手术、腹腔镜手术和开腹手术三种方法的治疗效果。应用SPSS 22.0处理数据,非正态计量资料采用[M(Q_(1),Q_(3))]表示,进行Wilcoxon秩和检验;计数资料采用[例(%)]表示,进行χ^(2)或Fisher确切概率法检验。P<0.05为差异有统计学意义。结果:年轻TSR患者耐受非手术治疗的机体应激能力强,术后恢复较快。他人打击伤有更多非手术治疗机会,其他各种受伤原因均不能作为选择治疗方式的依据,受伤严重程度是决定非手术治疗或手术治疗的关键因素。一阶梯非手术治疗107例,顺利康复103例,优良治愈(无并发症)率为96.3%;二阶梯腹腔镜手术治疗26例(包括非手术治疗组延迟性脾破裂出血改行腹腔镜脾切除2例),顺利完成手术24例,成功率为92.3%,顺利康复22例,优良治愈率为91.7%;三阶梯开腹手术治疗160例(包括腹腔镜中转开腹2例),顺利康复145例,优良治愈率为90.6%。结论:多层螺旋CT是诊断TSR的首选方法,依据血流动力学、AAST-OIS分级、是否合并其他脏器伤等因素选择三阶梯分层治疗方法,有利于减少手术创伤及其并发症,提高无创及微创治愈率。Objective:To explore the clinical significance of three-step stratified treatment strategy for traumatic splenic rupture(TSR)in improving the non-invasive and minimally invasive cure rate.Methods:The clinical data of 107 patients with TSR treated non-surgically and 182 patients with TSR treated surgically from July 2013 to September 2022 were retrospectively analyzed,and the therapeutic effects of non-surgical,laparoscopic and open surgery were analyzed.SPSS 22.0 was used to process the data,and the non-normal measurement data were represented by[M(Q_(1),Q_(3))],and Wilcoxon Rank Sum test was performed.The count data is represented by[cases(%)]and tested byχ^(2) or Fisher exact probability method.P<0.05 was considered statistically significant.Results:Young TSR patients have strong stress ability to tolerate non-surgical treatment and recover quickly after surgery.Other injuries have more opportunities for non-surgical treatment,and other causes of injury cannot be used as a basis for choosing treatment.The severity of injury is a key factor in determining non-surgical treatment or surgical treatment.In 107 cases,103 cases recovered successfully and the rate of excellent cure(no complications)was 96.3%.Twenty-six cases were treated with two-step laparoscopic surgery(including 2 cases in the non-surgical treatment group who underwent laparoscopic splenectomy for delayed splenic rupture and hemorrhage).24 cases successfully completed the operation,the success rate was 92.3%,22 cases successfully recovered,and the excellent cure rate was 91.7%.160 cases were treated with three-step laparotomy(including 2 cases converted to laparotomy by laparoscopy),145 cases recovered successfully,and the excellent cure rate was 90.6%.Conclusion:Multi-slice spiral CT is the first choice for the diagnosis of TSR.The selection of three-step stratification treatment based on hemodynamics,AAST-OIS grading,whether there are other organ injuries,etc.,is conducive to reducing surgical trauma and complications,and improving the non-invasi

关 键 词：创伤 外伤性脾破裂 多层螺旋CT 三阶梯分层治疗 

分 类 号：R657.62[医药卫生—外科学]