To compare the clinical efficacy of partial splenic artery embolization (PSAE) with conventional open surgery (OS) in the treatment of traumatic splenic rupture.

The literatures related to two surgical modalities, PSAE and OS, in the treatment of traumatic splenic rupture were retrieved in CNKI, Wanfang data, VIP, PubMed, Web of Science and Embase databases from the date of database establish to May 31, 2022. Data within the literatures were extracted and analyzed using RevMan 5.3 software.

A total of 5 238 patients within 16 literatures were finally included, including 1 037 in the PSAE group and 4 201 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<0.000 01), shorter operative time (WMD= -60.25, 95% CI: -71.99, -48.52; P<0.000 01), higher salvage success rate (WMD=4.00, 95% CI:1.32, 12.09; P=0.01), and PSAE group had shorter postoperative bed-off time (WMD= -14.44, 95% CI :-20.32, -8.55; P<0.000 01) and length of stay (WMD= -4.89, 95% CI: -5.86, -3.91; P<0.000 01) than OS group, with statistically significant differences. In terms of postoperative complication, the incidence of postoperative incisional infection (OR=0.21, 95% CI: 0.11, 0.37; P<0.000 01), postoperative intestinal obstruction (OR=0.24, 95% CI: 0.10, 0.55; P=0.000 8), and postoperative pneumonia (OR=0.44, 95% CI: 0.32, 0.61; P<0.000 01) in PSAE group were lower than that in OS group; however, the differences were not statistically significant when comparing postoperative splenic abscess, fever, and peritoneal effusion. Regarding the recovery of postoperative immune function, levels of CD3⁺ (WMD=9.27, 95% CI: 6.32, 12.22; P<0.000 01), CD4⁺ (WMD=5.60, 95% CI: 3.86, 7.34; P<0.000 01), and CD4⁺/CD8⁺ values (WMD=0.35, 95% CI: 0.18, 0.52; P<0.000 01) at one month postoperatively in PSAE group were higher than those in OS group, but the level of CD8⁺ at one month postoperatively was higher in OS group than that in PSAE group (WMD=-1.20, 95% CI: -1.72, -0.68; P<0.000 01).

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.