Russian Journal of Pediatric SurgeryRussian Journal of Pediatric SurgeryДетская хирургия1560-95102412-0677Eco-Vector63410.17816/ps634Original Study ArticlesОригинальные исследованияResearch ArticleFailures in the conservative treatment of transcapsular spleen injuries in childrenНеудачи в консервативном лечении чрескапсульных повреждений селезенки у детейhttps://orcid.org/0000-0002-2494-27354885-4209PikaloIlia A.ПикалоИлья Андреевич
Russian Federation

MD, Cand. Sci. (Medicine)

канд. мед. наук

pikalodoc@mail.ruhttps://mir.ismu.baikal.ru/ismu/page_user.php?id=1862https://orcid.org/0000-0003-0885-05637722-5010PodkamenevVladimir V.ПодкаменевВладимир Владимирович
Russian Federation

MD, Dr. Sci. (Medicine), Professor

д-р мед. наук, профессор

vpodkamenev@mail.ruhttps://mir.ismu.baikal.ru/ismu/page_user.php?id=2911https://orcid.org/0000-0002-0080-12921511-3402KarabinskayaOlga A.КарабинскаяОльга Арнольдовна
Russian Federation

MD, Cand. Sci. (Medicine)

канд. мед. наук

fastmail164@gmail.comhttps://mir.ismu.baikal.ru/ismu/page_user.php?id=4642Irkutsk State Medical UniversityИркутский государственный медицинский университет20032024261220232764144221703202319012024Copyright ©; 2023, Pikalo I.A., Podkamenev V.V., Karabinskaya O.A.Copyright ©; 2023, Пикало И.А., Подкаменев В.В., Карабинская О.А.2023Pikalo I.A., Podkamenev V.V., Karabinskaya O.A.Пикало И.А., Подкаменев В.В., Карабинская О.А.https://jps-nmp.ru/jour/article/view/634

BACKGROUND: Spontaneous arrest of bleeding from the spleen in children in case of transcapsular injuries is a fact which opens chances for non-surgical injury management. However, continued or delayed bleeding is a risk factor for hemorrhagic shock and conversion to surgery.

AIM: To study the incidence of continued and delayed intraperitoneal bleedings in non-operated spleen injuries in children.

MATERIALS AND METHODS: The prospective cohort study included patients with transcapsular spleen injuries who were hospitalized to the Children’s Clinical Hospital in Irkutsk from March 2002 to December 2022. Failure of the conservative treatment means that there appeared a need for surgical intervention in a child with spleen injury.

RESULTS: Out of 91 patient with spleen injury, surgical interventions were performed in 4 (4.4%) children within the first two hours due to unstable hemodynamics. Non-operative care was originally planned in 87 (95.6%) children, of which 80 (87.9%) cases were successful. Continued and delayed bleeding was observed in 23 children (25.3%). The failure rate in conservative treatment was 8.05% (7 of 87). Main reasons for unsuccessful conservative treatment were continued (n=5; 5.5%) and delayed (n=2; 2.2%) bleeding leading to hypotension.

CONCLUSION: Failures of the conservative treatment of transcapsular spleen injuries in children are associated with continued and delayed intraperitoneal bleeding. The probability of continued bleeding is 5.5%, of delayed one — 2.2%.

Обоснование. Особенностью чрескапсульных повреждений селезенки у детей является самопроизвольная остановка кровотечения из органа, что обусловливает возможность неоперативного лечения. Однако продолженное или отсроченное кровотечение рассматриваются в качестве факторов риска геморрагического шока и необходимости хирургического лечения.

Цель — изучить частоту встречаемости продолженного и отсроченного внутрибрюшинного кровотечения при неоперативном лечении травмы селезенки у детей.

Материалы и методы. В проспективное когортное исследование включены все пациенты (n=91) с чрескапсульной травмой селезенки, госпитализированные в Ивано-Матренинскую детскую клиническую больницу г. Иркутска за период с марта 2002 по декабрь 2022 г. Неудачное консервативное лечение рассматривалось как необходимость проведения любого хирургического вмешательства у ребенка с травмой селезенки.

Результаты. Из 91 пациента с травмой селезенки хирургическое лечение было выполнено в первые 2 ч четырем (4,4%) детям в связи с нестабильной гемодинамикой. Неоперативное лечение первоначально планировалось у 87 (95,6%) детей, из которых у 80 (87,9%) пациентов оно было успешным. Продолженное и отсроченное кровотечение наблюдалось у 23 детей (25,3%). Частота неудач в консервативном лечении составила 8,05% (7 из 87). Основной причиной безуспешного консервативного лечения явилось продолженное (n=5; 5,5%) и отсроченное (n=2; 2,2%) кровотечение, ведущее к гипотензии.

Заключение. Неудачи в консервативном лечении чрескапсульных повреждений селезенки у детей связаны с продолженным и отсроченным внутрибрюшинным кровотечением. Вероятность продолженного кровотечения составляет 5,5%, отсроченного — 2,2%.

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