KMID : 0371320110800010056
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Journal of the Korean Surgical Society 2011 Volume.80 No. 1 p.56 ~ p.60
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Extension of Nonoperative Management on Spleen Injury with Judicious Selection and Embolization; 10 Years of Experience
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Koo Tae-Young
Ra Yu-Mi Lee Sang-Eok Choi In-Seok Yoon Dae-Sung Jo Young-Jun Choi Won-Jun
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Abstract
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Purpose: We describe clinical outcomes of NOM on spleen injuries with judicious selection and embolization during the past 10 years.
Methods: From March 2000 to November 2009, 151 patients with splenic injury were included. Eighteen patients were excluded because of incomplete data. Patients¡¯ medical records were reviewed to examine admission demographics, laboratory results, radiologic findings as well as transfusion requirement, hospital stay, and ultimate outcomes.
Results: Twenty patients were chosen for non-operative management (NOM) after splenic embolization and 1/20 (5%) patient failed. There were 32 patients more than 55 years old (range, 55~87 years). Of these patients, 26 (81%) patients were chosen for NOM and 3 (11.5%) patients failed. According to OIS, 51 patients were grade 3; 26 patients, grade 4; and 6 patients, grade 5. Among grade 3, 49 (96%) were chosen for NOM with or without embolization and 1 (2%) patient failed; grade 4, 19 (73%) with NOM, 2 (7.6%) patients failed. Of all 133 patients with NOM or failed NOM (FNOM), there was 0 mortality in grade 3; 2, in grade 4; 2, in grade 5, excluding other causes of death. The mean ISS was significantly higher in the failed NOM group compared with successful NOM group (P=0.01). The group of failed NOM had a significantly higher mean OIS (P=0.00).
Conclusion: Aggressive but highly selective NOM on the base of clinicoradiologic parameters with the aid of angioembolization would result in a low failure rate and complication in the management of high grades (grade 3 or 4).
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KEYWORD
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Spleen injury, Nonoperative management, Angioembolization
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