pmjТихоокеанский медицинский журналPacific Medical Journal1609-1175TGMU10.17238/PmJ1609-1175.2018.1.72-74pmj-215Research ArticleМЕТОДИКАMETHODSКак избежать спленэктомии у ребенка с травмой селезенкиHOW TO AVOID SPLENECTOMY IN A CHILD WITH SPLENIC TRAUMAШапкинаА. Н.ShapkinaA. N.pedsurg2005@mail.ruКозловаМ. В.KozlovaM. V.noemail@neicon.ruШмыреваЕ. С.ShmyrevaE. S.noemail@neicon.ruШуматовВ. Б.ShumatovV. B.noemail@neicon.ruТихоокеанский государственный медицинский университетRussian FederationКраевая детская клиническая больница № 1Russian Federation201828032018017274Copyright © Шапкина А.Н., Козлова М.В., Шмырева Е.С., Шуматов В.Б., 20182018Шапкина А.Н., Козлова М.В., Шмырева Е.С., Шуматов В.Б.Shapkina A.N., Kozlova M.V., Shmyreva E.S., Shumatov V.B.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.tmj-vgmu.ru/jour/article/view/215

В КДКБ № 1 (Владивосток) в 2008-2017 гг. поступило 36 детей с травмой селезенки, у 13 выявлены разрывы органа, у остальных - гематомы и ушибы. Консервативное лечение начато 29 больным и было успешным в 28 случаях, лапароскопия проведена 5 детям (без конверсий). Лапаротомия выполнена в 3 случаях: резекция верхнего полюса селезенки и две спленэктомии. Летальность составила 2,8 % - погиб ребенок с разрывом органа на фоне острого лейкоза. Таким образом, консервативное лечение при гемодинамической стабильности больных с травмами селезенки должно быть методом выбора. Неудачи в консервативном лечении не ведут к увеличению летальности. При лапаротомии предпочтение должно быть отдано органосохраняющим методам - резекции органа и спленорафии.

Objective. In case of traumatic spleen injury, splenectomy is often performed. Authors in such a situation tried to adhere to the organ-preserving and conservative approach presenting in this work an algorithm for managing such patients. Methods. Data on 36 cases of spleen damage with closed abdominal trauma in children 2-14 years old, who were admitted to the Regional Children's Clinical Hospital No. 1 in 2008-2017 are presented. Results. The most informative and constant laboratory index of spleen damage with closed abdominal injury was leukocytosis registered in 94.3 % of cases. Conservative treatment was started by 29 patients and was successful in 28 cases, laparoscopy was performed for 5 children, and there were no conversions in this group. Three laparotomies were performed: resection of the superior pole of the spleen and two splenectomies (one with autotransplantation of the splenic tissue into the large omentum). Mortality was 2.8 % - a child died with organ rupture following the acute leucosis. Conclusions. Conservative treatment in case of hemodynamic stability in patients with spleen injuries should be a method of choice. Failures of conservative treatment do not lead to mortality increase. In case of laparotomy the preference should be given to organ-saving methods - resection of an organ and splenography.

закрытая травма животарезекция селезенкиспленорафияконсервативное лечениеclosed abdominal injuryspleen resectionsplenographyconservative treatmentReferencesAcker S.N., Petrun B., Partrick D.A. [et al.]. Lack of utility of repeat monitoring ofhemoglobin and hematocrit following blunt solid organ injury in children // J. Trauma Acute Care Surg. 2015. Vol. 79, No. 6. P. 991-994.Acker S.N., Petrun B., Partrick D.A. [et al.]. Lack of utility of repeat monitoring ofhemoglobin and hematocrit following blunt solid organ injury in children // J. Trauma Acute Care Surg. 2015. Vol. 79, No. 6. P. 991-994.Adelgais K.M., Kuppermann N., Kooistra J. [et al.]. Intra-Abdominal Injury Study Group of the Pediatric Emergency Care Applied Research Network (PECARN). Accuracy of the abdominal examination for identifying children with blunt intra-abdominal injuries // J. Pediatr. 2014. Vol. 165, No. 6. P. 1230-1235.Adelgais K.M., Kuppermann N., Kooistra J. [et al.]. Intra-Abdominal Injury Study Group of the Pediatric Emergency Care Applied Research Network (PECARN). Accuracy of the abdominal examination for identifying children with blunt intra-abdominal injuries // J. Pediatr. 2014. Vol. 165, No. 6. P. 1230-1235.Alamri Y., Moon D., Yen D.A. [et al.]. Ten-year experience of splenic trauma in New Zealand: the rise of non-operative management // NZ Med. J. 2017. Vol. 130, No. 1463. P. 11-18.Alamri Y., Moon D., Yen D.A. [et al.]. Ten-year experience of splenic trauma in New Zealand: the rise of non-operative management // NZ Med. J. 2017. Vol. 130, No. 1463. P. 11-18.Bairdain S., Litman H.J., Troy M. [et al.]. Twenty-years of splenic preservation at a level 1 pediatric trauma center // J. Pediatr. Surg. 2015. Vol. 50, No. 5. P. 864-868.Bairdain S., Litman H.J., Troy M. [et al.]. Twenty-years of splenic preservation at a level 1 pediatric trauma center // J. Pediatr. Surg. 2015. Vol. 50, No. 5. P. 864-868.Fernandes T.M., Dorigatti A.E., Pereira B.M. [et al.]. Nonoperative management of splenic injury grade IV is safe using rigid protocol // Rev. Col. Bras. Cir. 2013. Vol. 40, No. 4. P. 323-329.Fernandes T.M., Dorigatti A.E., Pereira B.M. [et al.]. Nonoperative management of splenic injury grade IV is safe using rigid protocol // Rev. Col. Bras. Cir. 2013. Vol. 40, No. 4. P. 323-329.Jeremitsky E., Smith R.S., Ong A.W. Starting the clock: defining nonoperative management of blunt splenic injury by time // Am. J. Surg. 2013. Vol. 205, No. 3. P. 298-301.Jeremitsky E., Smith R.S., Ong A.W. Starting the clock: defining nonoperative management of blunt splenic injury by time // Am. J. Surg. 2013. Vol. 205, No. 3. P. 298-301.Koca B., Topgül K., Yürüker S.S. [et al.]. Non-operative treatment approach for blunt splenic injury: is grade the unique criterion? // Ulus Travma Acil Cerrahi Derg. 2013. Vol. 19, No. 4. P. 337-342.Koca B., Topgül K., Yürüker S.S. [et al.]. Non-operative treatment approach for blunt splenic injury: is grade the unique criterion? // Ulus Travma Acil Cerrahi Derg. 2013. Vol. 19, No. 4. P. 337-342.Linnaus M.E., Langlais C.S., Garcia N.M. [et al.]. Failure of nonoperative management of pediatric blunt liver and spleen injuries: A prospective Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium study // J. Trauma Acute Care Surg. 2017. Vol. 82, No. 4. P. 672-679.Linnaus M.E., Langlais C.S., Garcia N.M. [et al.]. Failure of nonoperative management of pediatric blunt liver and spleen injuries: A prospective Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium study // J. Trauma Acute Care Surg. 2017. Vol. 82, No. 4. P. 672-679.Ong A.W, Eilertson K.E., Reilly E.F. [et al.]. Nonoperative management of splenic injuries: significance of age // J. Surg. Res. 2016. Vol. 201, No. 1. P. 134-140.Ong A.W, Eilertson K.E., Reilly E.F. [et al.]. Nonoperative management of splenic injuries: significance of age // J. Surg. Res. 2016. Vol. 201, No. 1. P. 134-140.Singer G., Rieder S., Eberl R. [et al.]. Comparison of two treatment eras and sonographic long-term outcome of blunt splenic injuries in children // Eur. J. Pediatr. 2013. Vol. 172, No. 9. P. 1187-1190.Singer G., Rieder S., Eberl R. [et al.]. Comparison of two treatment eras and sonographic long-term outcome of blunt splenic injuries in children // Eur. J. Pediatr. 2013. Vol. 172, No. 9. P. 1187-1190.Weinrich M., Dahmen R.P., Black K.J. [et al.]. Postoperative long-term results in high-grade traumatic ruptures of the spleen in children // Zentralbl. Chir. 2014. Vol. 139, No. 6. P. 632-637.Weinrich M., Dahmen R.P., Black K.J. [et al.]. Postoperative long-term results in high-grade traumatic ruptures of the spleen in children // Zentralbl. Chir. 2014. Vol. 139, No. 6. P. 632-637.Wisner D.H., Kuppermann N., Cooper A. [et al.]. Management of children with solid organ injuries after blunt torso trauma // J. Trauma Acute Care Surg. 2015. Vol. 79, No. 2. P. 206-214.Wisner D.H., Kuppermann N., Cooper A. [et al.]. Management of children with solid organ injuries after blunt torso trauma // J. Trauma Acute Care Surg. 2015. Vol. 79, No. 2. P. 206-214.

The authors declare that there are no conflicts of interest present.