选择性脾动脉栓塞在外伤性脾破裂治疗中的应用21例报告

[基金项目]2021年浙江省卫生健康科技计划项目（2021KY397）。

▲通讯作者脾动脉栓塞治疗创伤性脾破裂的临床特征及影响因素分析李敏献1 王　博1 周　龙2▲1.厦门长庚医院肝胆血管外科，福建厦门　361028；2.浙江省台州市立医院肝胆血管外科，浙江台州　318000[摘要] 目的 评估脾动脉栓塞治疗创伤性脾破裂临床效果，探讨影响治疗结果及出现并发症的危险因素。

方法 回顾性分析2015年1月1日至2022年1月1日台州市立医院、厦门长庚医院收治的63例创伤闭合性脾破裂并且进行脾动脉栓塞治疗患者的临床资料，分析其临床特征及影响预后的因素并建立预测模型。

结果 63例创伤闭合性脾破裂并且进行脾动脉栓塞治疗的病例，抢救成功60例、死亡2例、介入术后转开腹1例，成功率为95.24%。

治疗过程出现并发症15例。

经ROC 曲线分析，当创伤严重评分（ISS）≥27.5分时，其对并发症诊断最为敏感，此时敏感度达到46.70%，特异度达到77.10%；单因素分析，血红蛋白（Hb）、活化部分凝血活酶时间（APTT）、脾损伤分级（AAST）在并发症的发生率存在显著差异（P < 0.05）；多因素分析，APTT 和Hb 是影响并发症发生率的独立因素（P < 0.05）；应用nomogram 预测模型，APTT>36 s 出现并发症的可能性是≤36 s 的17.936倍，Hb[130，175）g/L 的并发症风险仅仅是Hb[70，90）g/L 的6%。

结论 ISS ≥27.5分时，其对并发症诊断最为敏感；Hb、APTT、AAST 是脾动脉栓塞治疗创伤性脾破裂出现并发症的影响因素，且APTT 和Hb 水平是影响并发症发生的独立因素。

[关键词] 脾动脉栓塞；脾破裂；危险因素；多因素分析[中图分类号] R657.6 [文献标识码] A [文章编号] 2095-0616（2024）07-0176-05DOI:10.20116/j.issn2095-0616.2024.07.40Clinical characteristics and influencing factors of splenic artery embolization in the treatment of traumatic splenic ruptureLI　Minxian 1 WANG　Bo 1 ZHOU　Long21.Hepatobiliary and Vascular Surgery, Xiamen Chang Gung Hospital, Fujian, Xiamen 361028, China;2. Hepatobiliary and Vascular Surgery, Taizhou Municipal Hospital, Zhejiang, Taizhou 318000, China[Abstract] Objective To evaluate the clinical efficacy of splenic artery embolization in the treatment of traumatic splenic rupture, and explore the risk factors that affect treatment outcomes and complications. Methods Retrospective analysis was conducted on the clinical data of 63 cases of traumatic closed splenic rupture treated with splenic artery embolization at Taizhou Municipal Hospital and Xiamen Chang Gung Hospital from January 1, 2015 to January 1, 2022, with their clinical characteristics and factors affecting prognosis analyzed, and predictive models established. Results Among 63 cases of traumatic closed splenic rupture treated with splenic artery embolization, 60 cases were successfully rescued, 2 cases died, and 1 case underwent laparotomy after interventional surgery, with a success rate of 95.24%. Complications occurred in 15 cases during the treatment process. According to ROC curve analysis, when the injury severity score (ISS) was ≥ 27.5 points, it was most sensitive to the diagnosis of complications, with a sensitivity of 46.70% and a specificity of 77.10%; univariate analysis showed significant differences in the incidence of complications among hemoglobin (Hb), activated partial thromboplastin time (APTT), and American association for the surgery of trauma (AAST) splenic injury scale (P < 0.05); multivariate analysis showed that APTT and Hb were independent factors affecting the incidence of complications (P < 0.05); the nomogram prediction model showed that the likelihood of complications occurring in APTT > 36 s was 17.936-fold higher than that occurring in APTT ≤ 36 s, and the risk of complications in Hb [130, 175) g/L was only 6% of that in Hb [70, 90) g/L. Conclusion When ISS is ≥ 27.5 points, it is the most sensitive for the diagnosis of complications. Hb, APTT, and AAST are the influencing factors for the occurrence of complications insplenic artery embolization treatment of traumatic splenic rupture, and APTT and Hb levels are independent factors affecting the occurrence of complications.[Key words] Splenic artery embolization; Splenic rupture; Risk factor; Multivariate analysis随着社会发展，创伤已成为威胁人类生命健康的首要危害。

浙江创伤外科2019年4月第24卷第2期ZH J J Traumatic,April2019,Vol.24,N（）.2•348«•诊治分析•急诊脾动脉栓塞在创伤性脾破裂保脾术中的应用张德华李新华朱延安张琪【摘要】目的探讨急诊脾动脉栓塞(splenic artery embolization SAE)在创伤性脾破裂保脾术中的应用方法回顾性分析本院2016年1月至2018年8月45例腹部增强CT提示U〜HI级创伤性脾破裂患者行急诊脾动脉栓塞术：结果45例患者均一次栓塞成功，其中36例患者行脾动脉主干近段栓塞，材料均选择钢圈联合明胶海绵，9例行远端明胶海绵止血；本组44例保脾成功，其中1例为明胶海绵栓塞再发出血后予以钢圈联合明胶海绵栓塞止血保脾成功；另1例为脾动脉钢圈联合明胶海绵栓塞术后第3天再发出血，予以开腹脾切除。

结论急诊脾动脉栓塞术可提高n~ni级创伤性脾破裂患者的保脾成功率，术后并发症少，保留了脾脏的功能，可缩短住院时间，值得临床推广应用【关键词】脾动脉栓塞；创伤性脾破裂；保脾【中图分类号】R657.6【文献标识码】A doi:10.3969/j.issn.1009-7147.2019.02.068脾脏是腹部闭合性创伤中最容易损伤的实质性脏器，约占20%~40%⑴创伤性脾破裂伴出血需要及时处理，传统以开腹脾切除为主，但近年来，随着对脾脏功能认识的深入，保留脾脏及其功能越来越受到重视，开腹行脾切除术受到挑战，有报道83%~95%的脾破裂患者能够通过非手术治疗达到保命、保脾和微创的三重目标叫且易于被患者及家属接受。

得益于腹部增强CT对脾脏损伤级别的判断，本院对45例腹部增强CT提示n〜m级创伤性脾破裂患者行急诊脾动脉栓塞术，取得了较好的临床效果，现报道如下.1资料与方法1.1一般资料：本组患者45例，男39例，女6例；年龄21〜72岁；就诊时间为0.5〜17小时受伤原因：交通伤24例，高处坠落伤13例，被人打伤8例匚行腹部CT增强后根据美国创伤外科学会脾脏损伤分级标准：II级损伤11例，ID级损伤34例。