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Journal of Trauma and Injury 2013;26(4):280-285.
The Choice of Management in Patients with Splenic Blunt Trauma: A Single Center Study
Ji Young Jang, Seung Hwan Lee, Jae Gil Lee
Department of Surgery, Yonsei University, College of Medicine, Seoul, Korea. jakii@yuhs.ac
외상성 비장 손상 환자의 치료방법의 선택: 단일 기관 연구
장지영, 이승환, 이재길
연세대학교 의과대학 외과학교실
Received: 5 November 2013   • Revised: 19 December 2013   • Accepted: 19 December 2013
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+/-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+/-3.4 mmol/L, base deficit; 5.8+/-4.4 mmol/L vs 1.9+/-1.4 mmol/L, 2.8+/-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.
Key Words: Blunt splenic injury; Nonoperative management; Embolization


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