探讨脾外伤分级及治疗选择方法。

回顾性分析2020年1月至2025年1月郴州市第一人民医院收治的260例脾外伤患者临床资料。其中男188例，女72例；年龄2~75岁，中位年龄39岁。车祸外伤161例，高处坠落伤48例，刀刺伤12例，钝击伤39例。单纯脾脏破裂69例，脾破裂合并脑外伤、多发骨折、胸外伤等腹腔外脏器损伤163例，脾破裂合并肝破裂16例，脾破裂合并胰腺破裂8例，脾破裂合并胃肠穿孔4例。根据中华医学会的脾损伤分级标准确定患者脾损伤分级。依据患者脾损伤分级、受伤的动能、受伤后生命体征变化及受伤累及的器官等制定相应的诊疗方案。治疗方法包括保守治疗、介入治疗、腹腔镜脾切除手术、开腹脾切除手术等。合并其他脏器损伤行相应手术或保守治疗。

Ⅰ级脾损伤12例、Ⅱ级24例，Ⅲ级159例，Ⅳ级65例。脾外伤患者救治成功率98.8%（257/260），其中外科手术226例，保守治疗32例，介入治疗2例。外科手术方式包括开腹脾切除加脾片自体移植191例，开腹脾部分切除3例，腹腔镜下脾切除29例，腹腔镜下脾部分切除3例；16例合并肝破裂同时行肝部分切除及肝破裂修补术，8例合并胰腺破裂同时行胰腺部分切除及修补术，4例合并胃肠穿孔同时行胃肠修补术。

脾外伤须依据患者脾损伤分级、受伤的动能、受伤后生命体征变化及受伤累及的器官来制定相应的诊疗方案，采用合适的治疗方法，紧急情况下开腹脾切除是挽救患者生命最有效的手段。

To explore the classification of splenic trauma and methods for treatment selection.

Clinical data of 260 patients with splenic trauma admitted to the First People's Hospital of Chenzhou from January 2020 to January 2025 were analyzed retrospectively. Among them, 188 patients were male and 72 female, aged from 2 to 75 years, with a median age of 39 years. Among 188 patients, 161 cases experienced traffic accident injuries, 48 cases of falling injuries, 12 cases of stab injuries and 39 cases of blunt injuries. 69 patients were diagnosed with splenic rupture alone, 163 cases of spleen rupture complicated with brain trauma, multiple fractures, chest trauma and other extraperitoneal organ injuries, 16 cases of splenic rupture complicated with liver rupture, 8 cases of splenic rupture complicated with pancreatic rupture and 4 cases of splenic rupture complicated with gastrointestinal perforation. The splenic trauma was graded to the grading standards of splenic injury of Chinese Medical Association, according to the grading, kinetic energy of patients' injury, the changes of vital signs after injury and the involved organs, the diagnosis and treatment regimens for splenic trauma were formulated. Treatment methods included conservative treatment, interventional treatment, laparoscopic and open splenectomy, etc. For those complicated with other organ injuries, corresponding surgery or conservative treatments were performed.

Twelve patients were assessed as grade Ⅰ, 24 cases of grade Ⅱ, 159 cases of grade Ⅲ and 65 cases of grade Ⅳ, respectively. The success rate of treatment for splenic trauma was 98.8%(257/260), including 226 cases of surgery, 32 cases of conservative treatment and 2 cases of interventional treatment. Surgical methods included splenectomy combined with splenic tissue autotransplantation in 191 cases, partial splenectomy in 3 cases, laparoscopic splenectomy in 29 cases and laparoscopic partial splenectomy in 3 cases, respectively. 16 patients complicated with liver rupture were simultaneously treated with partial hepatectomy and repair of liver rupture, 8 cases complicated with pancreatic rupture were simultaneously treated with partial pancreatectomy and repair, and 4 cases complicated with gastrointestinal perforation were simultaneously treated with gastrointestinal repair.

The diagnosis and treatment regimen of splenic trauma should be formulated based on the grading, kinetic energy of splenic injury, the changes of patients' vital signs after injury and the involved organs, and appropriate treatment methods should be adopted. Splenectomy is the most effective treatment for emergent patients.