Postoperative Ergebnisse höhergradiger traumatischer Milzrupturen bei Kindern im Langzeitverlauf

Zusammenfassung

-Resektion einschließlich Milzhilus, 1 Hemisplenektomie und 2 kaudale Polresektionen; bei 1 Patienten mit OIS Grad V erfolgte primär eine Splenektomie. Ergebnisse: Bei 1 der 4 die Milz teilerhaltend operierten Patienten (Hemisplenektomie) musste aufgrund einer Nachblutung am 1. postoperativen Tag eine Restsplenektomie durchgeführt werden. Infolge der 2. Operation benötigte dieser Patient 2 Erythrozytenkonzentrate, weitere Komplikationen traten nicht auf. Eine passagere Thrombozytose als Zeichen einer eingeschränkten Clearance-Funktion der Milz entwickelten nur die Patienten mit Splenektomie und ⅔-Resektion. In einer Kontrolluntersuchung (Follow-Up im Median 13 [1–101] Monate) wiesen alle die Milz teilerhaltend operierten Patienten eine große und arteriell perfundierte Restmilz auf. Schlussfolgerung: Der hohe Anteil primär die Milz teilerhaltender Operationen ist im überwiegend vorliegenden Grad IV der Milzrupturen nach dem OIS begründet. Bei ¾ der die Milz teilerhaltend operierten Patienten war dieses Vorgehen erfolgreich. Die niedrige Morbidität sowie die dokumentierte Perfusion der Restmilzen im Langzeitverlauf rechtfertigen ein die Milz erhaltendes Vorgehen auch bei erforderlicher Operation.

Abstract

of the spleen including the splenic vessels, one hemisplenectomy and two lower pole resections; in one patient with an OIS grade V rupture splenectomy was performed immediately. Results: In one patient treated with a spleen-preserving approach (hemisplenectomy) the remainder of the spleen had to be removed due to acute bleeding on the first postoperative day. This patient needed two units of blood transfused following the second operation. There were no other complications. The two patients with splenectomy and resection of ⅔ of the spleen developed a transient thrombocytosis indicating impaired clearance of the spleen. In a follow-up involving ultrasonography (median 13, range 1–101 months) all patients managed with partially spleen-saving surgery showed a large remnant spleen with arterial perfusion. Conclusion: The majority of primarily partially spleen-preserving operations result from OIS grade IV ruptures of the spleen. Use of a partially spleen-saving surgical approach was successful in ¾ of these patients. Low morbidity and documented perfusion of the remnant spleen at long-term follow-up indicate that a spleen-preserving technique is warranted if an operative approach is required.

Schlüsselwörter

Milz - Verletzung - stumpfes Bauchtrauma - Kinderchirurgie - Milzerhalt - immunologische Funktion

Key words

spleen - injury - blunt abdominal trauma - paediatric surgery - salvage of the spleen - immunological function

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