脾动脉栓塞术在多发伤合并脾脏损伤中的应用_West China Medical Journal

Authors：

 邓澎 ,  曹钰

四川大学华西医院急诊科（成都 610041）;

Corresponding author：

曹钰, Email: dr.yu.cao@gmail.com

Keywords：

多发伤; 脾动脉栓塞术; 介入治疗

DOI：

10.7507/1002-0179.20160047

Video：

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自从1981年首次报道脾脏损伤出血后介入栓塞治疗可作为脾切除之外的一种可选择的治疗方法后，脾动脉栓塞术在脾脏损伤中的应用已越来越多。在脾脏创伤出血的治疗选择中，脾动脉栓塞术治疗占有重要的地位，可以避免不必要的手术，降低手术本身造成的伤害，同时介入手术成功率高，在治疗后可以立即进行血管造影评估止血效果。多发伤并不是脾脏创伤出血患者行介入栓塞术的危险因素，反而脾动脉栓塞术为外科手术风险较高的多发伤合并脾脏损伤患者提供了另一种治疗方式。

Citation： 邓澎, 曹钰. 脾动脉栓塞术在多发伤合并脾脏损伤中的应用. West China Medical Journal, 2016, 31(1): 166-169. doi: 10.7507/1002-0179.20160047 Copy

1.	盛志勇, 黎鳌. 现代创伤学[M]. 北京:人民卫生出版社, 1996: 834-845.
2.	陈维庭. 首届全国多发伤学术会议纪要[J]. 中华创伤杂志, 1994, 10(1):33.
3.	Mucha P, Daly RC, Farnell MB. Selective management of blunt splenic trauma[J]. J Trauma, 1986, 26(11):970-979.
4.	Sclafani SJ. The role of angiographic hemostasis in salvage of the injured spleen[J]. Radiology, 1981, 141(3):645-650.
5.	Velmahos GC, Spaniolas K, Tabbara M, et al. Abdominal insufflation decreases blood loss without worsening the inflammatory response:implications for prehospital control of internal bleeding[J]. Am Surg, 2008, 74(4):297-301.
6.	Schroeppel TJ, Croce MA. Diagnosis and management of blunt abdominal solid organ injury[J]. Curr Opin Crit Care, 2007, 13(4):399-404.
7.	Haan JM, Bochicchio GV, Kramer N, et al. Nonoperative management of blunt splenic injury:a 5-year experience[J].J Trauma, 2005, 58(3):492-498.
8.	Galvan DA, Peitzman AB. Failure of nonoperative management of abdominal solid organ injuries[J]. Curr Opin Crit Care, 2006, 12(6):590-594.
9.	Watson GA, Rosengart MR, Zenati MS, et al. Nonoperative management of severe blunt splenic injury:are we getting better?[J]. J Trauma, 2006, 61(5):1113-1119.
10.	Smith J, Armen S, Cook CH, et al. Blunt splenic injuries:have we watched long enough?[J]. J Trauma, 2008, 64(3):656-663; discussion 663-665.
11.	瞿全. 脾切除后凶险性感染的预防和处理[J]. 外科理论与实践, 2007, 12(2):116-118.
12.	Godley CD, Warren RL, Sheridan RL, et al. Nonoperative management of blunt splenic injury in adults:age over 55 years as a powerful indicator for failure[J]. J Am Coll Surg, 1996, 183(2):133-139.
13.	Peitzman AB, Harbrecht BG, Rivera L, et al. Failure of observation of blunt splenic injury in adults:variability in practice and adverse Consequences[J]. J Am Coll Surg, 2005, 201(2):179-187.
14.	Cocanour CS, Moore FA, Ware DN, et al. Delayed complications of nonoperative management of blunt adult splenic trauma[J]. Arch Surg, 1998, 133(6):619-624.
15.	Bessoud B, Denys A, Calmes JM, et al. Nonoperative management of traumatic splenic injuries:is there a role for proximal splenic artery embolization?[J]. AJR Am J Roentgenol, 2006, 186(3):779-785.
16.	Harbrecht BG, Ko SH, Watson GA, et al. Angiography for blunt splenic trauma does not improve the success rate of nonapevative management[J]. J Trauma, 2007, 63(1):44-49.
17.	Smith HE, Biffl WL, Majercik SD, et al. Splenic artery embolization:have we gone too far?[J]. J Trauma, 2006, 61(3):541-546.
18.	Dent D, Alsabrook G, Erickson BA, et al. Blunt splenic injuries:high nonoperative management rate can be achieved with selective embolization[J]. J Trauma, 2004, 56(5):1063-1067.
19.	Mcintyre LK, Schiff M, Jurkovich GJ. Failure of nonoperative management of splenic injuries:causes and consequences[J]. Arch Surg, 2005, 140(6):563-569.
20.	Velmahos GC, Chan LS, Kamel E, et al. Nonoperative management of splenic injuries:have we gone too far?[J]. Arch Surg, 2000, 135(6):674-681.
21.	Fu CY, Wu SC, Chen RJ, et al. Evaluation of need for operative intervention in blunt splenic injury:intraperitoneal contrast extravasation has an increased probability of requiring operative intervention[J]. World J Surg, 2010, 34(11):2745-2751.
22.	Duchesne JC, Simmons JD, Schmieg RE Jr, et al. Proximal splenic angioembolization does not improve outcomes in treating blunt splenic injuries compared with splenectomy:a cohort analysis[J]. J Trauma, 2008, 65(6):1346-1351.
23.	Renzulli P, Gross T, Schnüriger B, et al. Management of blunt injuries to the spleen[J]. Br J Surg, 2010, 97(11):1696-1703.
24.	Hashemzadeh SH, Hashemzadeh KH, Dehdilani M, et al. Non-operative management of blunt trauma in abdominal solid organ injuries:a prospective study to evaluate the success rate and predictive factors of failure[J]. Minerva Chir, 2010, 65(3):267-274.
25.	Peitzman AB, Heil B, Rivera L, et al. Blunt splenic injury in adults:Multi-institutional Study of the Eastern Association for the Surgery of Trauma[J]. J Trauma, 2000, 49(2):177-187.
26.	Olthof DC, Joosse P, Van Der Vlies CH, et al. Prognostic factors for failure of nonoperative management in adults with blunt splenic injury:a systematic review[J]. J Trauma Acute Care Surg, 2013, 74(2):546-557.
27.	Sclafani SJ, Weisberg A, Scalea TM, et al. Blunt splenic injuries:nonsurgical treatment with CT, arteriography, and transcatheter arterial embolization of the splenic artery[J]. Radiology, 1991, 181(1):189-196.
28.	Hagiwara A, Yukioka T, Ohta S, et al. Nonsurgical management of patients with blunt splenic injury:efficacy of transcatheter arterial embolization[J]. AJR Am J Roentgenol, 1996, 167(1):159-166.
29.	Nix JA, Costanza M, Daley BJ, et al. Outcome of the current management of splenic injuries[J]. J Trauma, 2001, 50(5):835-842.
30.	Haan J, Scott J, Boyd-Kranis RL, et al. Admission angiography for blunt splenic injury:advantages and pitfalls[J]. J Trauma, 2001, 51(6):1161-1165.
31.	Shanmuganathan K, Mirvis SE, Boyd-Kranis R, et al. Nonsurgical management of blunt splenic injury:use of CT criteria to select patients for splenic arteriography and potential endovascular therapy[J]. Radiology, 2000, 217(1):75-82.
32.	Mattox KL, Feliciano DV, Moore EE. Trauma[M]. 4 th ed. New York, NY:McGraw-Hill, 2000:823-826.
33.	Hagiwara A, Murata A, Matsuda T, et al. The usefulness of transcatheter arterial embolization for patients with blunt polytrauma showing transient response to fluid resuscitation[J]. J Trauma, 2004, 57(2):271-277.
34.	Dasgupta N, Matsumoto AH, Arslan B, et al. Embolization therapy for traumatic splenic lacerations[J]. Cardiovasc Intervent Radiol, 2012, 35(4):795-806.
35.	Sclafani SJ, Shaftan GW, Scalea TM, et al. Nonoperative salvage of computed tomography-diagnosed splenic injuries:utilization of angiography for triage and embolization for hemostasis[J]. J Trauma, 1995, 39(5):818-827.
36.	Sutyak JP, Chiu WC, D'amelio LF, et al. Computed tomography is inaccurate in estimating the severity of adult splenic injury[J]. J Trauma, 1995, 39(3):514-518.
37.	Gauer JM, Gerber-Paulet S, Seiler C, et al. Twenty years of splenic preservation in trauma:lower early infection rate than in splenectomy[J]. World J Surg, 2008, 32(12):2730-2735.
38.	Wiseman J, Brown CV, Weng J, et al. Splenectomy for trauma increases the rate of early postoperative infections[J]. Am Surg, 2006, 72(10):947-950.
39.	Ekeh AP, Mccarthy MC, Woods RJ, et al. Complications arising from splenic embolization after blunt splenic trauma[J]. Am J Surg, 2005, 189(3):335-339.
40.	Clancy AA, Tiruta C, Ashman D, et al. The song remains the same although the instruments are changing:complications following selective non-operative management of blunt spleen trauma: a retrospective review of patients at a levelⅠtrauma centre from 1996 to 2007[J]. J Trauma Manag Outcomes, 2012, 6(1):4.
41.	Frandon J, Rodière M, Arvieux C, et al. Blunt splenic injury:outcomes of proximal versus distal and combined splenic artery embolization[J]. Diagn Interv Imaging, 2014, 95(9):825-831.
42.	Wu HM, Kortbeek JB. Management of splenic pseudocysts following trauma:a retrospective case series[J]. Am J Surg, 2006, 191(5): 631-634.
43.	Kaseje N, Agarwal S, Burch M, et al. Short-term outcomes of splenectomy avoidance in trauma patients[J]. Am J Surg, 2008, 196(2):213-217.
44.	Gaarder C, Dormagen JB, Eken T, et al. Nonoperative management of splenic injuries:improved results with angioembolization[J]. J Trauma, 2006, 61(1):192-198.
45.	王荫槐, 赵宏, 韩铭钧, 等. 介入治疗闭合性脾破裂21例[J]. 中华创伤杂志, 1998, 14(S1):112-113.
46.	Schnüriger B, Inaba K, Konstantinidis A, et al. Outcomes of proximal versus distal splenic artery embolization after trauma: a systematic review and meta-analysis[J]. J Trauma, 2011, 70(1):252-260.
47.	华积德. 多发伤的紧急处理[J]. 中华创伤杂志, 2000, 16(8):62-63.
48.	刘东波, 杨植, 张琳娜, 等. 外伤性脾破裂脾动脉栓塞的治疗[J]. 介入放射学杂志, 2007, 16(9):645-647.

1. 盛志勇, 黎鳌. 现代创伤学[M]. 北京:人民卫生出版社, 1996: 834-845.
2. 陈维庭. 首届全国多发伤学术会议纪要[J]. 中华创伤杂志, 1994, 10(1):33.
3. Mucha P, Daly RC, Farnell MB. Selective management of blunt splenic trauma[J]. J Trauma, 1986, 26(11):970-979.
4. Sclafani SJ. The role of angiographic hemostasis in salvage of the injured spleen[J]. Radiology, 1981, 141(3):645-650.
5. Velmahos GC, Spaniolas K, Tabbara M, et al. Abdominal insufflation decreases blood loss without worsening the inflammatory response:implications for prehospital control of internal bleeding[J]. Am Surg, 2008, 74(4):297-301.
6. Schroeppel TJ, Croce MA. Diagnosis and management of blunt abdominal solid organ injury[J]. Curr Opin Crit Care, 2007, 13(4):399-404.
7. Haan JM, Bochicchio GV, Kramer N, et al. Nonoperative management of blunt splenic injury:a 5-year experience[J].J Trauma, 2005, 58(3):492-498.
8. Galvan DA, Peitzman AB. Failure of nonoperative management of abdominal solid organ injuries[J]. Curr Opin Crit Care, 2006, 12(6):590-594.
9. Watson GA, Rosengart MR, Zenati MS, et al. Nonoperative management of severe blunt splenic injury:are we getting better?[J]. J Trauma, 2006, 61(5):1113-1119.
10. Smith J, Armen S, Cook CH, et al. Blunt splenic injuries:have we watched long enough?[J]. J Trauma, 2008, 64(3):656-663; discussion 663-665.
11. 瞿全. 脾切除后凶险性感染的预防和处理[J]. 外科理论与实践, 2007, 12(2):116-118.
12. Godley CD, Warren RL, Sheridan RL, et al. Nonoperative management of blunt splenic injury in adults:age over 55 years as a powerful indicator for failure[J]. J Am Coll Surg, 1996, 183(2):133-139.
13. Peitzman AB, Harbrecht BG, Rivera L, et al. Failure of observation of blunt splenic injury in adults:variability in practice and adverse Consequences[J]. J Am Coll Surg, 2005, 201(2):179-187.
14. Cocanour CS, Moore FA, Ware DN, et al. Delayed complications of nonoperative management of blunt adult splenic trauma[J]. Arch Surg, 1998, 133(6):619-624.
15. Bessoud B, Denys A, Calmes JM, et al. Nonoperative management of traumatic splenic injuries:is there a role for proximal splenic artery embolization?[J]. AJR Am J Roentgenol, 2006, 186(3):779-785.
16. Harbrecht BG, Ko SH, Watson GA, et al. Angiography for blunt splenic trauma does not improve the success rate of nonapevative management[J]. J Trauma, 2007, 63(1):44-49.
17. Smith HE, Biffl WL, Majercik SD, et al. Splenic artery embolization:have we gone too far?[J]. J Trauma, 2006, 61(3):541-546.
18. Dent D, Alsabrook G, Erickson BA, et al. Blunt splenic injuries:high nonoperative management rate can be achieved with selective embolization[J]. J Trauma, 2004, 56(5):1063-1067.
19. Mcintyre LK, Schiff M, Jurkovich GJ. Failure of nonoperative management of splenic injuries:causes and consequences[J]. Arch Surg, 2005, 140(6):563-569.
20. Velmahos GC, Chan LS, Kamel E, et al. Nonoperative management of splenic injuries:have we gone too far?[J]. Arch Surg, 2000, 135(6):674-681.
21. Fu CY, Wu SC, Chen RJ, et al. Evaluation of need for operative intervention in blunt splenic injury:intraperitoneal contrast extravasation has an increased probability of requiring operative intervention[J]. World J Surg, 2010, 34(11):2745-2751.
22. Duchesne JC, Simmons JD, Schmieg RE Jr, et al. Proximal splenic angioembolization does not improve outcomes in treating blunt splenic injuries compared with splenectomy:a cohort analysis[J]. J Trauma, 2008, 65(6):1346-1351.
23. Renzulli P, Gross T, Schnüriger B, et al. Management of blunt injuries to the spleen[J]. Br J Surg, 2010, 97(11):1696-1703.
24. Hashemzadeh SH, Hashemzadeh KH, Dehdilani M, et al. Non-operative management of blunt trauma in abdominal solid organ injuries:a prospective study to evaluate the success rate and predictive factors of failure[J]. Minerva Chir, 2010, 65(3):267-274.
25. Peitzman AB, Heil B, Rivera L, et al. Blunt splenic injury in adults:Multi-institutional Study of the Eastern Association for the Surgery of Trauma[J]. J Trauma, 2000, 49(2):177-187.
26. Olthof DC, Joosse P, Van Der Vlies CH, et al. Prognostic factors for failure of nonoperative management in adults with blunt splenic injury:a systematic review[J]. J Trauma Acute Care Surg, 2013, 74(2):546-557.
27. Sclafani SJ, Weisberg A, Scalea TM, et al. Blunt splenic injuries:nonsurgical treatment with CT, arteriography, and transcatheter arterial embolization of the splenic artery[J]. Radiology, 1991, 181(1):189-196.
28. Hagiwara A, Yukioka T, Ohta S, et al. Nonsurgical management of patients with blunt splenic injury:efficacy of transcatheter arterial embolization[J]. AJR Am J Roentgenol, 1996, 167(1):159-166.
29. Nix JA, Costanza M, Daley BJ, et al. Outcome of the current management of splenic injuries[J]. J Trauma, 2001, 50(5):835-842.
30. Haan J, Scott J, Boyd-Kranis RL, et al. Admission angiography for blunt splenic injury:advantages and pitfalls[J]. J Trauma, 2001, 51(6):1161-1165.
31. Shanmuganathan K, Mirvis SE, Boyd-Kranis R, et al. Nonsurgical management of blunt splenic injury:use of CT criteria to select patients for splenic arteriography and potential endovascular therapy[J]. Radiology, 2000, 217(1):75-82.
32. Mattox KL, Feliciano DV, Moore EE. Trauma[M]. 4 th ed. New York, NY:McGraw-Hill, 2000:823-826.
33. Hagiwara A, Murata A, Matsuda T, et al. The usefulness of transcatheter arterial embolization for patients with blunt polytrauma showing transient response to fluid resuscitation[J]. J Trauma, 2004, 57(2):271-277.
34. Dasgupta N, Matsumoto AH, Arslan B, et al. Embolization therapy for traumatic splenic lacerations[J]. Cardiovasc Intervent Radiol, 2012, 35(4):795-806.
35. Sclafani SJ, Shaftan GW, Scalea TM, et al. Nonoperative salvage of computed tomography-diagnosed splenic injuries:utilization of angiography for triage and embolization for hemostasis[J]. J Trauma, 1995, 39(5):818-827.
36. Sutyak JP, Chiu WC, D'amelio LF, et al. Computed tomography is inaccurate in estimating the severity of adult splenic injury[J]. J Trauma, 1995, 39(3):514-518.
37. Gauer JM, Gerber-Paulet S, Seiler C, et al. Twenty years of splenic preservation in trauma:lower early infection rate than in splenectomy[J]. World J Surg, 2008, 32(12):2730-2735.
38. Wiseman J, Brown CV, Weng J, et al. Splenectomy for trauma increases the rate of early postoperative infections[J]. Am Surg, 2006, 72(10):947-950.
39. Ekeh AP, Mccarthy MC, Woods RJ, et al. Complications arising from splenic embolization after blunt splenic trauma[J]. Am J Surg, 2005, 189(3):335-339.
40. Clancy AA, Tiruta C, Ashman D, et al. The song remains the same although the instruments are changing:complications following selective non-operative management of blunt spleen trauma: a retrospective review of patients at a levelⅠtrauma centre from 1996 to 2007[J]. J Trauma Manag Outcomes, 2012, 6(1):4.
41. Frandon J, Rodière M, Arvieux C, et al. Blunt splenic injury:outcomes of proximal versus distal and combined splenic artery embolization[J]. Diagn Interv Imaging, 2014, 95(9):825-831.
42. Wu HM, Kortbeek JB. Management of splenic pseudocysts following trauma:a retrospective case series[J]. Am J Surg, 2006, 191(5): 631-634.
43. Kaseje N, Agarwal S, Burch M, et al. Short-term outcomes of splenectomy avoidance in trauma patients[J]. Am J Surg, 2008, 196(2):213-217.
44. Gaarder C, Dormagen JB, Eken T, et al. Nonoperative management of splenic injuries:improved results with angioembolization[J]. J Trauma, 2006, 61(1):192-198.
45. 王荫槐, 赵宏, 韩铭钧, 等. 介入治疗闭合性脾破裂21例[J]. 中华创伤杂志, 1998, 14(S1):112-113.
46. Schnüriger B, Inaba K, Konstantinidis A, et al. Outcomes of proximal versus distal splenic artery embolization after trauma: a systematic review and meta-analysis[J]. J Trauma, 2011, 70(1):252-260.
47. 华积德. 多发伤的紧急处理[J]. 中华创伤杂志, 2000, 16(8):62-63.
48. 刘东波, 杨植, 张琳娜, 等. 外伤性脾破裂脾动脉栓塞的治疗[J]. 介入放射学杂志, 2007, 16(9):645-647.

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脾动脉栓塞术在多发伤合并脾脏损伤中的应用

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