Abstract：
OBJECTIVE: To describe the experience of a single level 1 trauma center in the management of blunt splenic injuries (BSI).
METHODS: This is a retrospective study with Institutional Review Board approval. The medical records of 450 patients with BSI treated between January 2016 and December 2022 were reviewed. Seventy-two patients were treated with splenic artery embolization (SAE), met the study criteria, and were eligible for data analysis. Spleen injuries were graded in accordance with the American Association for the Surgery of Trauma Organ Injury Scale. Univariate data analysis was performed, with P < 0.05 considered statistically significant.
RESULTS: The splenic salvage rate was 90.3% (n = 65/72). Baseline demographics were similar between the groups (P > 0.05). Distal embolization with Gelfoam® had similar rates of splenic salvage to proximal embolization with coils (90% vs. 94.1%, P > 0.05). There was no significant difference in the rate of splenic infarction between distal embolization with Gelfoam® (20%, 4/20) and proximal embolization with coils (17.6%, 3/17) (P > 0.05). There was no significant difference in procedure length (68 vs. 75.8 min) or splenic salvage rate (88.5% vs. 92.1%) between proximal and distal embolization (P > 0.05). There was no significant difference in procedure length (69.1 vs. 73.6 min) or splenic salvage rate (93.1% vs. 86.4%) between Gelfoam® and coil embolization (P > 0.05). Combined proximal and distal embolization was associated with a higher rate of splenic abscess formation (25%, 2/8) when compared with proximal (0%, 0/26) or distal (0%, 0/38) embolization alone (P = 0.0003). The rate of asymptomatic and symptomatic splenic infarction was significantly higher in patients embolized at combined proximal and distal locations (P = 0.04, P = 0.01).
CONCLUSIONS: The endovascular management of BSI is safe and effective. The overall splenic salvage rate was 90.3%. Distal embolization with Gelfoam® was not associated with higher rates of splenic infarction when compared with proximal embolization with coils. Combined proximal and distal embolization was associated with a higher incidence of splenic infarction and splenic abscess formation.
CONCLUSIONS: Distal splenic embolization with Gelfoam® is safe and may be beneficial in the setting of blunt splenic trauma.
METHODS: This is a retrospective study with Institutional Review Board approval. The medical records of 450 patients with BSI treated between January 2016 and December 2022 were reviewed. Seventy-two patients were treated with splenic artery embolization (SAE), met the study criteria, and were eligible for data analysis. Spleen injuries were graded in accordance with the American Association for the Surgery of Trauma Organ Injury Scale. Univariate data analysis was performed, with P < 0.05 considered statistically significant.
RESULTS: The splenic salvage rate was 90.3% (n = 65/72). Baseline demographics were similar between the groups (P > 0.05). Distal embolization with Gelfoam® had similar rates of splenic salvage to proximal embolization with coils (90% vs. 94.1%, P > 0.05). There was no significant difference in the rate of splenic infarction between distal embolization with Gelfoam® (20%, 4/20) and proximal embolization with coils (17.6%, 3/17) (P > 0.05). There was no significant difference in procedure length (68 vs. 75.8 min) or splenic salvage rate (88.5% vs. 92.1%) between proximal and distal embolization (P > 0.05). There was no significant difference in procedure length (69.1 vs. 73.6 min) or splenic salvage rate (93.1% vs. 86.4%) between Gelfoam® and coil embolization (P > 0.05). Combined proximal and distal embolization was associated with a higher rate of splenic abscess formation (25%, 2/8) when compared with proximal (0%, 0/26) or distal (0%, 0/38) embolization alone (P = 0.0003). The rate of asymptomatic and symptomatic splenic infarction was significantly higher in patients embolized at combined proximal and distal locations (P = 0.04, P = 0.01).
CONCLUSIONS: The endovascular management of BSI is safe and effective. The overall splenic salvage rate was 90.3%. Distal embolization with Gelfoam® was not associated with higher rates of splenic infarction when compared with proximal embolization with coils. Combined proximal and distal embolization was associated with a higher incidence of splenic infarction and splenic abscess formation.
CONCLUSIONS: Distal splenic embolization with Gelfoam® is safe and may be beneficial in the setting of blunt splenic trauma.
摘要：
目的：描述单个1级创伤中心在钝性脾损伤（BSI）治疗中的经验。
方法：这是一项获得机构审查委员会批准的回顾性研究。回顾了2016年1月至2022年12月期间450例BSI患者的病历。72例患者行脾动脉栓塞术(SAE),符合研究标准，并有资格进行数据分析。脾脏损伤根据美国创伤器官损伤外科协会量表进行分级。进行单变量数据分析，P<0.05被认为具有统计学意义。
结果：脾抢救率为90.3%(n=65/72)。两组基线人口统计学相似(P>0.05)。使用Gelfoam®的远端栓塞与使用线圈的近端栓塞的脾抢救率相似（90％与94.1%,P>0.05)。使用Gelfoam®的远端栓塞之间的脾梗死发生率没有显着差异（20％，4/20）和线圈近端栓塞（17.6％，3/17)(P>0.05)。手术时间没有显着差异（68vs.75.8分钟)或脾残率(88.5%vs.92.1％）在近端和远端栓塞之间（P>0.05）。手术时间没有显着差异（69.1vs.73.6分钟)或脾残率(93.1%与86.4％）在Gelfoam®和线圈栓塞之间（P>0.05）。近端和远端联合栓塞与脾脓肿形成率较高相关(25%，2/8)与近端(0%，0/26）或远端（0%，0/38)单独栓塞(P=0.0003)。在近端和远端联合位置栓塞的患者中，无症状和有症状的脾梗死的发生率显着升高（P=0.04，P=0.01）。
结论：BSI的血管内治疗是安全有效的。总体脾抢救率为90.3%。与使用线圈的近端栓塞相比，使用Gelfoam®的远端栓塞与更高的脾梗死发生率无关。近端和远端联合栓塞与脾梗死和脾脓肿形成的发生率较高有关。
结论：用Gelfoam®行远端脾栓塞术是安全的，并且在钝性脾外伤的情况下可能是有益的。
方法：这是一项获得机构审查委员会批准的回顾性研究。回顾了2016年1月至2022年12月期间450例BSI患者的病历。72例患者行脾动脉栓塞术(SAE),符合研究标准，并有资格进行数据分析。脾脏损伤根据美国创伤器官损伤外科协会量表进行分级。进行单变量数据分析，P<0.05被认为具有统计学意义。
结果：脾抢救率为90.3%(n=65/72)。两组基线人口统计学相似(P>0.05)。使用Gelfoam®的远端栓塞与使用线圈的近端栓塞的脾抢救率相似（90％与94.1%,P>0.05)。使用Gelfoam®的远端栓塞之间的脾梗死发生率没有显着差异（20％，4/20）和线圈近端栓塞（17.6％，3/17)(P>0.05)。手术时间没有显着差异（68vs.75.8分钟)或脾残率(88.5%vs.92.1％）在近端和远端栓塞之间（P>0.05）。手术时间没有显着差异（69.1vs.73.6分钟)或脾残率(93.1%与86.4％）在Gelfoam®和线圈栓塞之间（P>0.05）。近端和远端联合栓塞与脾脓肿形成率较高相关(25%，2/8)与近端(0%，0/26）或远端（0%，0/38)单独栓塞(P=0.0003)。在近端和远端联合位置栓塞的患者中，无症状和有症状的脾梗死的发生率显着升高（P=0.04，P=0.01）。
结论：BSI的血管内治疗是安全有效的。总体脾抢救率为90.3%。与使用线圈的近端栓塞相比，使用Gelfoam®的远端栓塞与更高的脾梗死发生率无关。近端和远端联合栓塞与脾梗死和脾脓肿形成的发生率较高有关。
结论：用Gelfoam®行远端脾栓塞术是安全的，并且在钝性脾外伤的情况下可能是有益的。
