背景:近几十年来,脾血管栓塞术(SAE)作为非手术治疗(NOM)的辅助手段,已成为钝性脾损伤(BSI)患者的重要干预措施。SAE改善患者预后,抢救脾脏,并避免与脾切除术相关的并发症。本系统评价旨在评估BSI患者与SAE相关的失败率和并发症。
方法:系统文献检索(PubMed,Scopus,和Cochrane图书馆)专注于钝性创伤病例中脾血管栓塞的详细研究。包括符合预定纳入标准的文章。这篇综述检查了适应症,结果,故障率,和SAE的并发症。
结果:在599篇确定的文章中,33符合纳入标准。这些包括29个回顾性研究,三项前瞻性研究,和一项随机对照试验。该分析包括25,521例BSI患者和3,835例SAE患者。SAE的总失败率为5.3%。主要并发症主要为再出血(4.8%),梗塞(4.6%),脓肿形成(4%)。轻微并发症为发热(18.4%),胸腔积液(13.1%),和线圈迁移(3.9%)。其他并发症包括脾萎缩,脾囊肿,血肿,和入路部位并发症,如脾/股骨夹层。总的来说,栓塞后死亡率为0.08%.
结论:SAE是管理BSI的有价值的辅助手段,故障率低。然而,这种治疗方式并非没有潜在严重并发症的风险.
BACKGROUND: Over recent decades, splenic angioembolization (SAE) as an adjunct to non-operative management (NOM) has emerged as a prominent intervention for patients with blunt splenic injuries (BSI). SAE improves patient outcomes, salvages the spleen, and averts complications associated with splenectomy. This systematic review aimed to evaluate the failure rate and complications related to SAE in patients with BSI.
METHODS: A systematic literature search (PubMed, SCOPUS, and Cochrane Library) focused on studies detailing splenic angioembolization in blunt trauma cases. Articles that fulfilled the predetermined inclusion criteria were included. This review examined the indications, outcomes, failure rate, and complications of SAE.
RESULTS: Among 599 identified articles, 33 met the inclusion criteria. These comprised 29 retrospective studies, three prospective studies, and one randomized control trial. The analysis encompassed 25,521 patients admitted with BSI and 3,835 patients who underwent SAE. The overall failure rate of SAE was 5.3 %. Major complications predominantly were rebleeding (4.8 %), infarction (4.6 %), and abscess formation (4 %). Minor complications were fever (18.4 %), pleural effusion (13.1 %), and coil migration (3.9 %). Other complications included splenic atrophy, splenic cyst, hematoma, and access site complications such as splenic/femoral dissection. Overall, post embolization mortality was 0.08 %.
CONCLUSIONS: SAE is a valuable adjunct in managing BSI, with a low failure rate. However, this treatment modality is not without the risk of potentially serious complications.