■腹部外伤性损伤后,开腹手术常切除脾脏,几乎没有努力保护脾脏。
目的探讨手术治疗(脾修复与脾切除术)与行剖腹手术的外伤性脾损伤患者预后的关系,并确定脾修复是否与脾切除术相比具有更低的死亡率。
■这是一项基于创伤登记的队列研究,使用美国外科医生学会创伤质量改善计划数据库,从2013年1月至2019年12月。参与者包括入院后6小时内因外伤而接受剖腹手术的严重脾损伤的成年患者(缩写损伤量表[AIS]3-5级)。数据分析于2023年4月至8月进行。
■严重外伤性脾损伤患者的脾修复与脾切除术.
■主要结局是住院死亡率。使用不同的统计方法比较结果,包括1:1精确匹配,以连续条件逻辑回归分析为主要分析和多变量逻辑回归,倾向得分匹配,和逆概率加权作为敏感性分析。
■共有11247名患者(中位[IQR]年龄,35[24-52]岁;8179名男性[72.7%])患有严重的外伤性脾损伤,正在进行剖腹手术。其中,10820例(96.2%)患者行脾切除术,427例(3.8%)接受脾修复。在接受初始脾挽救手术的患者中,23(5.3%)在随后的住院期间需要脾切除术;400例保留脾的患者与400例接受脾切除术的患者相匹配(年龄相匹配,性别,低血压,创伤机制,AIS脾脏等级,和头部的AIS组[0-2、3和4-5],脸,脖子,胸部,脊柱,以及下肢和上肢)。脾修复组的死亡率明显低于脾切除术组(26例[6.5%]vs51例[12.8%])。随后通过条件回归分析验证了脾修复与较低死亡率的关联(调整后的比值比,0.4;95%CI,0.2-0.9;P=0.03)。多变量逻辑回归,倾向得分匹配,逆概率加权证实了这种关联。
■在这项回顾性队列研究中,与外伤性脾损伤后开腹手术中的脾切除术相比,脾修复与较低的死亡率独立相关.这些发现表明,在某些严重脾损伤的情况下,可能需要努力保护脾脏。
UNASSIGNED: The spleen is often removed in laparotomy after traumatic abdominal injury, with little effort made to preserve the spleen.
UNASSIGNED: To explore the association of surgical management (splenic repair vs splenectomy) with outcomes in patients with traumatic splenic injuries undergoing laparotomy and to determine whether splenic repair is associated with lower mortality compared with splenectomy.
UNASSIGNED: This is a trauma registry-based cohort study using the American College of Surgeons Trauma Quality Improvement Program database from January 2013 to December 2019. Participants included adult patients with severe splenic injuries (Abbreviated Injury Scale [AIS] grades 3-5) undergoing laparotomy after traumatic injury within 6 hours of admission. Data analysis was performed from April to August 2023.
UNASSIGNED: Splenic repair vs splenectomy in patients with severe traumatic splenic injury.
UNASSIGNED: The primary outcome was in-hospital mortality. Outcomes were compared using different statistical approaches, including 1:1 exact matching with consecutive conditional logistic regression analysis as the primary analysis and multivariable logistic regression, propensity score matching, and inverse-probability weighting as sensitivity analyses.
UNASSIGNED: A total of 11 247 patients (median [IQR] age, 35 [24-52] years; 8179 men [72.7%]) with a severe traumatic splenic injury undergoing laparotomy were identified. Of these, 10 820 patients (96.2%) underwent splenectomy, and 427 (3.8%) underwent splenic repair. Among patients who underwent an initial splenic salvage procedure, 23 (5.3%) required a splenectomy during the subsequent hospital stay; 400 patients with splenic preservation were matched with 400 patients who underwent splenectomy (matched for age, sex, hypotension, trauma mechanism, AIS spleen grade, and AIS groups [0-2, 3, and 4-5] for head, face, neck, thorax, spine, and lower and upper extremity). Mortality was significantly lower in the splenic repair group vs the splenectomy group (26 patients [6.5%] vs 51 patients [12.8%]). The association of splenic repair with lower mortality was subsequently verified by conditional regression analysis (adjusted odds ratio, 0.4; 95% CI, 0.2-0.9; P = .03). Multivariable logistic regression, propensity score matching, and inverse-probability weighting confirmed this association.
UNASSIGNED: In this retrospective cohort study, splenic repair was independently associated with lower mortality compared with splenectomy during laparotomy after traumatic splenic injury. These findings suggest that efforts to preserve the spleen might be indicated in selected cases of severe splenic injuries.