외상성 비장 손상 5 2예의 임상적 고찰

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 mecha-nism 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 (14.8 vs 30.9 days). Conclusions : Non-opeartive 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.