경희대학교
의과대학 외과학교실
장연수·고영관·이상목·홍성화·오수명
Clinical
Analysis of Management of Traumatic Splenic Injury
Yeon
Soo Chang, M.D. , Young Gwan Ko, M.D. , Sang Mok Lee, M.D.,
Sung
Wha Hong, M.D. , Su Myung Oh, M.D.
Department
of General Surgery, Kyunghee University Hospital. Seoul. Korea
Backgrounds:
A total splenectomy was considered as the standard method to management of splenic
injury. However, recently, splenic preservation has been emphasized because of the
spleen's important immunologic function, especially in the young. This study was
conducted to evaluate the safety and the indications of non-operative management
of traumatic splenic injury.
Methods:
The medical records of 52 patients who were managed for traumatic splenic injury
between Jan. 1, 1990, and Jun. 30, 1999, were evaluated. The clinical manifestations,
the mechanism of injury, The diagnostic method, the grade of injury, the initial
management, the initial treatment mode, treatment course, and complications were
investigated.
Results:
Thirty(30) patients were initially treated medically with transfusions and intensive
monitoring. A delayed operation was required in 9 patients (30%) who suffered a
severe splenic injury more than grade III. Twenty-one(21) of the 30 patients (70%)
who suffered a splenic injury less than grade III were successfully managed non-operatively.
Nineteen(19) of the 22 patients (86%) who required an initial operation suffered
a severe splenic injury more than grade III. There were differences between the
non-operative and the operative groups in transfusion amount (1.1 vs 6.5 pints)
and in hospital stay (l4.8 vs 30.9 days)
Conclusions:
Non-operative management of traumatic splenic injury will be successful in patients
who are hemodynamically stable with adequate resuscitation and a small amount of
transfusion and who have suffered injuries below grade III.
Key
Words: Splenic injury, Non-operative management |
