目的:本研究旨在阐明累及主动脉的钝性脾损伤的治疗方法。我们假设在这种情况下,非手术管理失败率会更高,需要增加出血控制手术。
方法:使用了2017年至2019年创伤质量改善计划的数据。所有钝性脾外伤患者均考虑纳入。我们对有和没有胸或腹主动脉损伤的钝性脾外伤患者进行了比较,以确定治疗中的任何潜在差异。
结果:在研究期间的32,051例钝性脾损伤患者中,752(2.3%)并发主动脉损伤。在2:1倾向得分匹配之后,确定主动脉损伤的存在并没有显着影响脾动脉栓塞术(TAE)的利用(7.2%vs.8.7%,p=0.243)或脾切除术或脾修补术的必要性(15.3%vs.15.7%,p=0.853)。此外,主动脉损伤不是导致TAE失败的重要因素,无论受伤的位置或严重程度如何。同时发生脾和主动脉损伤的患者在最初4小时内需要更多的红细胞输注(0ml[0,900]vs.0毫升[0,650],p=0.001),并表现出更高的死亡率(10.6%vs.7.9%,p=0.038)。
结论:这项研究表明,并发主动脉和脾损伤的患者会出现更严重的情况。死亡率更高,和延长住院时间。主动脉损伤的存在并未实质性影响TAE的使用或脾切除术或脾修补术的必要性。这种类型的患者可以根据当前的治疗指南进行管理。尽管如此,鉴于他们预后较差,他们需要迅速和积极的干预。
OBJECTIVE: This study aimed to elucidate the treatment approach for blunt splenic injuries concurrently involving the aorta. We hypothesized that non-operative management failure rates would be higher in such cases, necessitating increased hemorrhage control surgeries.
METHODS: Data from the Trauma Quality Improvement Program spanning 2017 to 2019 were utilized. All patients with blunt splenic trauma were considered for inclusion. We conducted comparisons between blunt splenic trauma patients with and without thoracic or abdominal aortic injuries to identify any potential disparities in treatment.
RESULTS: Among the 32,051 patients with blunt splenic injuries during the study period, 752 (2.3%) sustained concurrent aortic injuries. Following 2:1 propensity score matching, it was determined that the presence of aortic injuries did not significantly affect the utilization of splenic transarterial angioembolization (TAE) (7.2% vs. 8.7%, p = 0.243) or the necessity for splenectomy or splenorrhaphy (15.3% vs. 15.7%, p = 0.853). Moreover, aortic injuries were not a significant factor contributing to TAE failure, regardless of the location or severity of the injury. Patients with simultaneous splenic and aortic injuries required more red blood cell transfusion within first 4 hours (0 ml [0, 900] vs. 0 ml [0, 650], p = 0.001) and exhibited a higher mortality rate (10.6% vs. 7.9%, p = 0.038).
CONCLUSIONS: This study demonstrated that patients with concurrent aortic and splenic injuries presented with more severe conditions, higher mortality rates, and extended hospital stays. The presence of aortic injuries did not substantially influence the utilization of TAE or the necessity for splenectomy or splenorrhaphy. Patients of this type can be managed in accordance with current treatment guidelines. Nonetheless, given their less favorable prognosis, they necessitate prompt and proactive intervention.