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.