探讨外伤性脾破裂（TSR）三阶梯分层治疗策略对提高患者无创及微创治愈率的临床意义。

回顾分析2013年7月至2022年9月107例非手术治疗和182例手术治疗的TSR患者临床资料，分析非手术、腹腔镜手术和开腹手术三种方法的治疗效果。应用SPSS 22.0处理数据，非正态计量资料采用[M（Q₁，Q₃）]表示，进行Wilcoxon秩和检验；计数资料采用[例（%）]表示，进行χ²或Fisher确切概率法检验。P<0.05为差异有统计学意义。

年轻TSR患者耐受非手术治疗的机体应激能力强，术后恢复较快。他人打击伤有更多非手术治疗机会，其他各种受伤原因均不能作为选择治疗方式的依据，受伤严重程度是决定非手术治疗或手术治疗的关键因素。一阶梯非手术治疗107例，顺利康复103例，优良治愈（无并发症）率为96.3%；二阶梯腹腔镜手术治疗26例（包括非手术治疗组延迟性脾破裂出血改行腹腔镜脾切除2例），顺利完成手术24例，成功率为92.3%，顺利康复22例，优良治愈率为91.7%；三阶梯开腹手术治疗160例（包括腹腔镜中转开腹2例），顺利康复145例，优良治愈率为90.6%。

多层螺旋CT是诊断TSR的首选方法，依据血流动力学、AAST-OIS分级、是否合并其他脏器伤等因素选择三阶梯分层治疗方法，有利于减少手术创伤及其并发症，提高无创及微创治愈率。

To explore the clinical significance of three-step stratified treatment strategy for traumatic splenic rupture (TSR) in improving the non-invasive and minimally invasive cure rate.

The clinical data of 107 patients with TSR treated non-surgically and 182 patients with TSR treated surgically from July 2013 to September 2022 were retrospectively analyzed, and the therapeutic effects of non-surgical, laparoscopic and open surgery were analyzed. SPSS 22.0 was used to process the data, and the non-normal measurement data were represented by [M（Q₁，Q₃）], and Wilcoxon Rank Sum test was performed. The count data is represented by [cases (%)] and tested by χ² or Fisher exact probability method. P<0.05 was considered statistically significant.

Young TSR patients have strong stress ability to tolerate non-surgical treatment and recover quickly after surgery. Other injuries have more opportunities for non-surgical treatment, and other causes of injury cannot be used as a basis for choosing treatment. The severity of injury is a key factor in determining non-surgical treatment or surgical treatment. In 107 cases, 103 cases recovered successfully and the rate of excellent cure (no complications) was 96.3%. Twenty-six cases were treated with two-step laparoscopic surgery (including 2 cases in the non-surgical treatment group who underwent laparoscopic splenectomy for delayed splenic rupture and hemorrhage). 24 cases successfully completed the operation, the success rate was 92.3%, 22 cases successfully recovered, and the excellent cure rate was 91.7%. 160 cases were treated with three-step laparotomy (including 2 cases converted to laparotomy by laparoscopy), 145 cases recovered successfully, and the excellent cure rate was 90.6%.

Multi-slice spiral CT is the first choice for the diagnosis of TSR. The selection of three-step stratification treatment based on hemodynamics, AAST-OIS grading, whether there are other organ injuries, etc., is conducive to reducing surgical trauma and complications, and improving the non-invasive and minimally invasive cure rate.