| ВХОД ДЛЯ ПАЦИЕНТОВ
Коллеги! мне как не общему хирургу сложно говорить о лечении травмы органов брюшной полости.
Но работая плечом к плечу с общими хирургами, иногда возникает вопрос надо ли делать спленэктомию, когда кровотечения нет.
Получили тезис на эту тему:
Исследователи выявили, что попытки неоперативного лечения повреждения селезенки не увеличивает количество сложний и смертность.
Усилия по сохранению селезенки безопасны.
Successful nonoperative management of splenic injuries in the polytraumatized patient
M.P.J. Teuben, T.J. Blokhuis, R. Spijkerman, L.P.H. Leenen University Medical Center Utrecht, The Netherlands INTRODUCTION
Selective nonoperative management (NOM) has become the treatment of choice for patients with blunt splenic injury. Historically, nonoperative management is contraindicated in polytraumatized patients. However, in our institution all hemodynamically stable polytrauma patients without concomitant hollow organ injuries are selected for NOM. The current study was undertaken to evaluate the outcomes of selective nonoperative management for blunt splenic injuy in polytrauma patients.
All adult polytrauma patients (ISS>16) admitted over a 12-year period with blunt splenic injury were selected from our prospectively registered trauma database. Patients were categorized by the type of treatment they received. So group one consisted of patients initially selected for NOM and group two included all patients which underwent direct surgical intervention. We compared complications, hospital length of stay (LOS), ICU-stay, failure of NOM and mortality.
A total of 93 eligible polytrauma patients sustaining blunt splenic injury were admitted, with a median age of 35 (range,16 to 75) an ISS of 29 (IQR, 25-38). Fifty-three hemodynamically unstable patients underwent direct emergency laparotomy, and 40 patients with comparable splenic injury were initially selected for nonoperative management.
As anticipated, patients treated by direct operative intervention had a significantly worse hemodynamic status, higher ISS as well as higher grades of splenic injuries as compared to those patients treated by NOM.
The median hospital-LOS did not significantly differ between groups and was 16 (IQR, 9-26) in the NOM group and 18 (IQR, 5-41) in the OM group. Furthermore, there were no significant differences encountered in the number of complications and duration of ICU-stay between groups. Failure of NOM occurred in 10 patients and resulted in 6 total splenectomies and 4 spleen preserving procedures. Patients initially treated by surgical intervention were significantly less frequently treated by a spleen preserving procedure (3 out of 53 procedures, p<0.05) as compared to patients which failed NOM. A total of 10 fatalities were seen in the OM group, mortality did not occur in the patients initially selected for NOM.
Our findings show that selective nonoperative management for adult polytrauma patients with blunt splenic injury is not associated with increased morbidity or mortality. Moreover, our strive for preservation of splenic function in polytrauma patients is safe.
|"По форме правильно, а по существу - издевательство" В.И.Ленин|