背景:结肠镜检查引起的脾损伤很少见,但死亡率很高。虽然历史上保守治疗低度损伤或高度损伤脾切除术,脾动脉栓塞术的应用越来越广泛,反映了外部钝性创伤的现代治疗指南。本系统综述评估了已发表的结肠镜检查导致脾动脉栓塞治疗的脾损伤病例的结果。
方法:对发表的有关结肠镜检查主要采用脾动脉栓塞治疗期间脾损伤的文章进行了系统评价,脾切除术,或从1977年到2022年的splenorrhy。数据点包括人口统计,既往手术史,结肠镜检查的适应症,延迟诊断,治疗,伤害等级,脾动脉栓塞位置,脾保存(抢救),和死亡率。
结果:接受脾动脉栓塞治疗的30例患者平均年龄65岁(SD9),其中67%为女性,83%避免脾切除术和6.7%的死亡率。81%的脾动脉栓塞位于脾门近端。接受脾切除术治疗的163例患者平均年龄65岁(SD11),女性占66%,死亡率为5.5%。3例接受中位年龄60岁(范围59-70岁)的脾修补术的患者均避免了脾切除术,无死亡。脾动脉栓塞和脾切除术组之间的死亡率没有差异(p=0.81)。
结论:脾动脉栓塞治疗结肠镜导致的脾损伤是一种有效的治疗选择。鉴于与脾切除术相比,脾挽救的已知益处,包括对被包裹的生物体保持免疫功能,低成本,住院时间缩短,对于合适的患者,应将栓塞纳入结肠镜检查引起的脾损伤的治疗途径。
Splenic injury due to colonoscopy is rare, but has high mortality. While historically treated conservatively for low-grade injuries or with splenectomy for high-grade injuries, splenic artery embolisation is increasingly utilised, reflecting modern treatment guidelines for external blunt trauma. This systematic review evaluates outcomes of published cases of splenic injury due to colonoscopy treated with splenic artery embolisation.
A systematic review was performed of published articles concerning splenic injury during colonoscopy treated primarily with splenic artery embolisation, splenectomy, or splenorrhaphy from 1977 to 2022. Datapoints included demographics, past surgical history, indication for colonoscopy, delay to diagnosis, treatment, grade of injury, splenic artery embolisation location, splenic preservation (salvage), and mortality.
The 30 patients treated with splenic artery embolisation were of mean age 65 (SD 9) years and 67% female, with 83% avoiding splenectomy and 6.7% mortality. Splenic artery embolisation was proximal to the splenic hilum in 81%. The 163 patients treated with splenectomy were of mean age 65 (SD 11) years and 66% female, with 5.5% mortality. Three patients treated with splenorrhaphy of median age 60 (range 59-70) years all avoided splenectomy with no mortality. There was no difference in mortality between splenic artery embolisation and splenectomy cohorts (p = 0.81).
Splenic artery embolisation is an effective treatment option in splenic injury due to colonoscopy. Given the known benefits of splenic salvage compared to splenectomy, including preserved immune function against encapsulated organisms, low cost, and shorter hospital length of stay, embolisation should be incorporated into treatment pathways for splenic injury due to colonoscopy in suitable patients.