Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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The Choice of Management in Patients with Splenic Blunt Trauma : A Single Center Study

외상성 비장 손상 환자의 치료방법의 선택: 단일 기관 연구

  • Jang, Ji Young (Department of Surgery, Yonsei University, College of Medicine) ;
  • Lee, Seung Hwan (Department of Surgery, Yonsei University, College of Medicine) ;
  • Lee, Jae Gil (Department of Surgery, Yonsei University, College of Medicine)
  • 장지영 (연세대학교 의과대학 외과학교실) ;
  • 이승환 (연세대학교 의과대학 외과학교실) ;
  • 이재길 (연세대학교 의과대학 외과학교실)
  • Received : 2013.11.05
  • Accepted : 2013.12.19
  • Published : 2013.12.31
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Abstract

Purpose: Nowadays, non-operative management increases in patients with blunt splenic injury due to development of diagnostic and interventional technique. The purpose of this study is to evaluate the management in patients with blunt splenic injury and effect of clinical state such as shock on the choice of management. Methods: From April 2007 to July 2013, we retrospectively reviewed the medical charts of fifty patients who had splenic injury after blunt trauma. The demographic characteristics, American Association for the Surgery of Trauma (AAST) grade of splenic injury, management method (emergency operation, angiographic embolization or observation) and clinical outcome were analyzed. Results: The mean age was $41.5{\pm}21.4$ years and male was 44(88%). Twenty patients(40%) were in shock condition initially and five patients(10%) underwent emergency operation due to hemodynamic instability. Emergency angiographic embolization was performed in 20 patients(40%) and 25 patients were managed conservatively. When patients were divided into shock group (SG) and non-shock group (NSG), Patients in SG had significantly higher serum lactate level and base deficit than NSG (lactate; $4.5{\pm}3.4$ mmol/L, base deficit; $5.8{\pm}4.4$ mmol/L vs $1.9{\pm}1.4$ mmol/L, $2.8{\pm}2.5$ mmol/L, p=0.007, p=0.013). There was no significant difference of AAST grade and contrast blush rate in abdomen CT between two groups. Among 45 patients with non-operative management, four patients(8.9%) got delayed angiographic embolization and 3 patient died from companied organ injury. Conclusion: Non-operative management can be acceptable management option in patients with splenic blunt trauma under intensive hemodynamic monitoring.

Keywords

References

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