Non-operative management of blunt hepatic and splenic injuries-practical aspects and value of radiological scoring systems.

IF 0.6 4区医学 Q4 SURGERY European Surgery-Acta Chirurgica Austriaca Pub Date : 2018-01-01 Epub Date: 2018-07-20 DOI:10.1007/s10353-018-0545-x

Margot Fodor, Florian Primavesi, Dagmar Morell-Hofert, Matthias Haselbacher, Eva Braunwarth, Benno Cardini, Eva Gassner, Dietmar Öfner, Stefan Stättner

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引用次数: 25

Abstract

Background: Non-operative management (NOM) of blunt hepatic and splenic injuries has become popular in haemodynamically stable adult patients, despite uncertainty about efficacy, patient selection, and details of management. Up-to-date strategies and practical recommendations are presented.

Methods: A selective literature search was conducted in PubMed and the Cochrane Library (1989-2016).

Results: No randomized clinical trial was found. Non-randomized controlled trials and large retrospective and prospective series dominate. Few systematic reviews and meta-analyses are available. NOM of selected patients with blunt liver and spleen injuries is associated with low morbidity and mortality. Only data of limited evidence are available on intensity and duration of patient monitoring, repeat imaging, antithrombotic prophylaxis and return to normal activity. There is high-level evidence on early mobilisation and post-splenectomy vaccination.

Conclusion: NOM of blunt liver or spleen injuries is a worldwide trend, but the literature does not provide high-grade evidence for this strategy.

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钝性肝脾损伤的非手术治疗——放射学评分系统的实用性和价值。

背景:钝性肝脾损伤的非手术治疗(NOM)在血流动力学稳定的成年患者中越来越流行，尽管在疗效、患者选择和治疗细节方面存在不确定性。提出了最新的战略和实用建议。方法:在PubMed和Cochrane Library(1989-2016)中进行选择性文献检索。结果:未发现随机临床试验。非随机对照试验和大型回顾性和前瞻性研究占主导地位。很少有系统综述和荟萃分析可用。选择钝性肝脾损伤患者的NOM与低发病率和死亡率相关。在患者监测的强度和持续时间、重复成像、抗血栓预防和恢复正常活动方面，仅有有限的证据数据。有高水平的证据表明，早期动员和脾切除术后接种疫苗。结论:钝性肝或脾损伤的NOM是世界范围内的趋势，但文献没有提供高质量的证据。

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来源期刊

European Surgery-Acta Chirurgica Austriaca 医学-外科

CiteScore

1.10

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： The journal European Surgery – Acta Chirurgica Austriaca focuses on general surgery, endocrine surgery, thoracic surgery, heart and vascular surgery. Special features include new surgical and endoscopic techniques such as minimally invasive surgery, robot surgery, and advances in surgery-related biotechnology and surgical oncology. The journal especially addresses benign and malignant esophageal diseases, i.e. achalasia, gastroesophageal reflux disease, Barrett’s esophagus, and esophageal adenocarcinoma. In keeping with modern healthcare requirements, the journal’s scope includes inter- and multidisciplinary disease management (diagnosis, therapy and surveillance).