Safety And Efficacy Of Partial Splenic Artery Embolization Versus Conventional Open Surgery For Traumatic Splenic Rupture: A Meta-analysis

Objective:To compare the clinical efficacy of partial splenic artery embolization(PSAE)with conventional open surgery(OS)in the treatment of traumatic splenic rupture.Methods:The literatures related to two surgical modalities,PSAE and OS,for the treatment of traumatic splenic rupture were retrieved in CNKI,Wanfang data,VIP,Pub Med,Web of Science and Embase databases from the date of database creation to May 31,2022.Data within the literature were extracted and analyzed using Rev Man 5.3 software.Results:A total of 5238 patients within 16 literatures were finally included,including 1037 in the PSAE group and 4201 in the OS group.Meta analysis results showed that compared to OS group,PSAE group had less intraoperative bleeding(WMD=-392.95,95%CI:-667.52,-118.38;P=0.005),less intraoperative blood transfusion(WMD=-433.87,95%CI:-582.85,-284.89;P<0.00001),shorter operative time(WMD=-60.25,95%CI:-71.99,-48.52;P<0.00001),higher salvage success rate(WMD=4.00,95%CI: 1.32,12.09;P=0.01),and PSAE group had a shorter postoperative time to bed(WMD=-14.44,95% CI:-20.32,-8.55;P<0.00001)and length of stay(WMD=-4.89,95% CI:-5.86,-3.91;P<0.00001)than OS group,with statistically significant differences(P<0.05).In terms of the incidences of postoperative complication,the incidence of postoperative incisional infection(OR=0.21,95%CI: 0.11,0.37;P<0.00001),postoperative intestinal obstruction(OR=0.24,95% CI: 0.10,0.55;P=0.0008),and postoperative pneumonia(OR=0.44,95% CI: 0.32,0.61;P<0.00001)in PSAE group were lower than OS group;however,the differences were not statistically significant when comparing postoperative splenic abscess,postoperative fever,and postoperative peritoneal effusion.Regarding the recovery of postoperative immune function,levels of CD3+(WMD=9.27,95% CI: 6.32,12.22;P<0.00001),CD4+(WMD=5.60,95%CI:3.86,7.34;P<0.00001),and CD4+/CD8+ values(WMD=0.35,95% CI: 0.18,0.52;P<0.00001)at one month postoperatively in PSAE group were higher than that in OS group,but the level of CD8+ at one month postoperatively were higher in OS group than that in PSAE group(WMD=-1.20,95% CI:-1.72,-0.68;P<0.00001).Conclusion:In the diagnosis and treatment of patients with traumatic splenic rupture,PSAE has its unique advantages over OS,with simple operation,shorter operation time,less intraoperative bleeding,fewer postoperative complications,shorter hospital stay,and early recovery of immune function after surgery,which is worthy of clinical selection.