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1.
脾动脉栓塞治疗包膜下脾破裂12例报告   总被引:2,自引:0,他引:2  
张贵阳  陆国强 《腹部外科》1997,10(6):277-277
1990年5月~1996年5月,我们对12例包膜下脾破裂患者,采用经脾动脉推注明胶海绵栓塞治疗,效果满意,现报告如下。临床资料一、一般资料:男10例,女2例;年龄20~48岁。均为闭合伤。其中坠落伤3例,车祸4例,跌伤1例,斗殴2例,石块击伤2例。入院时间在伤后1~15h。全组均经B型超声或CT确诊。无腹腔内其它脏器损伤。二、治疗方法:采用S山nger法,将Cor山s-LH导管经股动脉穿刺插管至脾动脉。经脾动脉造影证实为包膜下脾破裂后,将明胶海绵(ZmmX10mm大小)揉成圆柱状,用注射器经导管注入脾动脉栓塞。边栓塞边行牌动脉造影,直至破裂…  相似文献   

2.
选择性出血动脉栓塞在外伤性脾脏破裂出血处理中的应用   总被引:3,自引:0,他引:3  
目的探讨选择性出血动脉栓塞在处理外伤性脾脏破裂出血中的效果。方法采用Seldinger技术穿刺右侧股动脉,把导管放至脾动脉后造影,显示脾脏出血部位,然后把微导管放至出血(叶、段)血管,注入PVA、明胶海绵颗粒等栓塞剂进行止血。结果44例脾动脉造影显示脾外伤(夏氏分级)Ⅱ级23例,Ⅲ级19例,Ⅳ级2例。44例均顺利完成选择性出血血管栓塞,其中脾叶动脉血管栓塞13例,脾段动脉血管栓塞31例;1次栓塞成功35例,再次栓塞成功9例。无继发出血及开腹手术病例,无死亡病例。术后1周血红蛋白、红细胞压积恢复正常。44例随访0.5~1年,无再出血、严重感染及其他并发症发生。结论选择性脾动脉出血血管栓塞是治疗外伤性脾破裂出血的一种有效、简便、微创的方法。  相似文献   

3.
闭合性脾外伤326例诊治分析   总被引:1,自引:0,他引:1  
目的 总结闭合性脾外伤的治疗经验,探讨保脾的治疗方法.方法 回顾性分析326例闭合性脾外伤的临床资料.结果 326例闭合性脾外伤患者中197例行非手术治疗,129例行手术治疗,其中脾动脉结扎联合脾修补术选择性治疗外伤性脾破裂97例,脾切除32例.结论 有选择的非手术治疗Ⅰ~Ⅱ级脾破裂是安全有效的治疗方法,轻度的肝肾损伤、腹腔外器官合并伤及患者的年龄并不影响非手术治疗的疗效.脾动脉结扎联合睥修补术选择性治疗Ⅱ~Ⅲ级外伤性脾破裂是安全可靠的,远期效果好.  相似文献   

4.
目的 探讨脾动脉栓塞术(splenic artetial embolization,SAE)对外伤性脾破裂的治疗效果及并发症的处理.方法 采用SeIdiniger法行脾动脉栓塞治疗外伤性脾破裂共28例.结果 所有患者出血立即停止,其中4例行2次栓塞.28例均有脾区疼痛.22例发热.脾动脉栓塞5天后血小板、白细胞上升近1倍,7天后恢复至正常范围.28例随访6~36个月.查免疫球蛋白、CT等结果满意,未有再出血及暴发性感染(overwhelming postsplenectomy infection,OPSI)发生.结论 脾动脉栓塞不但有良好的止血作用.而且能使患者避免手术切脾,又能保留脾脏的免疫功能,可在非手术治疗失败时选用,是治疗外伤性脾破裂的一种有效治疗方法.  相似文献   

5.
目的:比较选择性睥动脉栓塞术与非手术治疗外伤性脾破裂的临床应用。方法:回顾性分析1992~2006年我院进行的23例选择性脾动脉栓塞和32例非手术治疗睥破裂的患者。结果:选择性脾动脉栓塞组无输血,非手术组1例输血。选择性脾动脉栓塞组2例并发左侧胸腔积液,1例并发左下肺感染;非手术组1例出现并发脾周脓肿(P=0.298)。非手术组保脾成功率为81.3%(26/32)。选择性脾动脉栓塞组成功率为100%(23/23,P=0.035)。两组患者均无死亡病例。选择性脾动脉栓塞组平均住院(7.9±2.1)d,非手术组平均住院(11.9±4.6)d,P=0.045。结论:脾Ⅰ、Ⅱ级损伤适宜保脾治疗,选择性脾动脉栓塞术比非手术治疗更为安全有效。  相似文献   

6.
成人外伤性脾破裂非手术治疗55例分析   总被引:3,自引:0,他引:3  
目的对非手术治疗外伤性脾破裂进行临床分析,为外伤性脾破裂临床治疗方法的选择提供初步证据。方法回顾1992年至2006年我院收治的包括选择性脾动脉栓塞和保守治疗的非手术治疗脾破裂患者55例,对治疗成功率、死亡率和并发症发生率进行分析比较,并评价其卫生经济学效益。结果治疗总成功率87.27%(48/55),元患者死亡。损伤严重程度分组,51例脾Ⅰ、Ⅱ级损伤,总有效率90.19%(46/51),再次栓塞或开腹手术5例。4例脾外伤Ⅲ级患者,2例非手术治疗成功,再次栓塞或开腹手术2例。治疗分组分析,传统保守治疗组保脾成功率为81.3%(26/32),选择性脾动脉栓塞组成功率为100%(23/23)(P=0.035)。选择性脾动脉栓塞组2例并发左侧胸腔积液,1例并发左下肺感染;保守治疗组1例并发脾周脓肿。选择性脾动脉栓塞组平均住院日较保守治疗组[(7.9±4.2.1)d比(11.9±4.4.6)d]明显缩短(P=0.045),但住院花费增加[(4216±668.4)元比(2616±437.8)元](P〈0.05)。结论脾损伤Ⅰ、Ⅱ级患者适宜保脾治疗,选择性脾动脉栓塞术比传统非手术保守治疗疗效更为可靠,在医疗设备和经济条件允许的情况下建议考虑栓塞治疗。  相似文献   

7.
目的探讨外伤闭合性脾破裂行脾保留手术的术式及疗效。方法回顾性分析我院2001年6月至2012年5月期间对外伤闭合性脾破裂行脾保留手术的32例患者的临床资料。结果 32例外伤闭合性脾破裂患者中行单纯黏合剂止血6例(Ⅰ级),单纯缝合修补6例(Ⅰ级),缝合修补加黏合剂止血13例(Ⅰ/Ⅱ级),脾部分切除手术4例(Ⅱ/Ⅲ级),脾动脉结扎加脾修补术3例(Ⅱ/Ⅲ级)。32例行脾保留手术患者中除1例因手术后再出血行脾切除获治愈外,其余31例均获保脾成功,术后3~6个月行B超和CT检查示脾脏生长良好,IgM、C3、C4等免疫功能指标均在正常范围。结论对Ⅰ~Ⅲ级外伤闭合性脾破裂行脾保留手术安全、可行,疗效好,对保留和恢复脾脏功能有重要意义。  相似文献   

8.
脾动脉灌注栓塞治疗外伤性脾破裂的临床研究   总被引:5,自引:0,他引:5  
目的;研究脾动脉抑肽酶灌注、明胶海绵栓塞对外伤性脾破裂的止血效果,及灌注栓塞后病人血液流变学和免疫功能的变化。方法:采用Seldinger技术,先进行脾动脉造影以明确诊断并进行Gall分级,然后用抑肽酶50万U行脾动脉灌注及明胶海绵栓塞脾动脉主干或出血区脾动脉分支。术后1、3、6、12个月分别测定病人血液流变学,RBC、PLT、淋巴细胞计数,C3、C4、免疫球蛋白IgG、IgM,T淋巴细胞亚群CD3、CD4、CD8。结果:36例脾破裂病人35例止血效果确切,保脾成功。1例因脾动脉扭曲插管失败而行开腹手术治疗。35例病人术后1、3、6、12个月测定血RBC、PLT、淋巴细胞计数,血液流变学,C3、C4,IgG、IgM,CD3、CD4、CD8,结果与正常人相比差异无显著性意义(P>0.05)。结论:用抑肽酶行脾动脉灌注、明胶海绵栓塞是治疗脾破裂Gall 分级I-Ⅲ级可靠而有效的方法;术后病人血液流变学及免疫功能正常。  相似文献   

9.
脾损伤行脾保留手术的可行性分析   总被引:1,自引:0,他引:1  
目的:探讨脾损伤后行脾保留的可行性及必要性。方法:59例中单纯粘合剂止血8例(工级),单纯缝合修补7例(Ⅰ/Ⅱ级),单纯缝合修补+粘合胶止血15例(Ⅰ/Ⅱ级),脾部分切除6例(Ⅱ/Ⅲ级),脾破裂大网膜捆扎+脾动脉结扎10例(Ⅱ/Ⅲ级),原位保留脾蒂+后腹膜自体脾移植2例(Ⅳ级),脾切除+自体脾组织移植1例(Ⅳ级),DSA下行脾动脉栓塞术(其中部分脾栓塞术PSE7例,脾动脉主干栓塞SAE3例)10例(Ⅰ/Ⅱ/Ⅲ级)。结果:59例脾保留手术均获成功,复查脾组织存活,术后免疫功能指标均正常。结论:脾损伤后行脾保留手术是安全可行的,对于保留和恢复脾脏功能具有重要价值。  相似文献   

10.
保脾治疗(手术和非手术)对于保留脾破裂患者的脾功能具有重要意义。脾动脉栓塞是外伤性脾破裂保脾治疗中一种安全有效的重要措施,能够提高保脾治疗的成功率。1997年1月-2009年2月笔者对119例外伤性脾破裂患者行脾动脉栓塞治疗,76例保脾成功,报道如下。  相似文献   

11.
Abstract Background:   Proximal embolization of the splenic artery (PSAE) has recently been reported for traumatic splenic injury. The suggested mechanism of action entails a decrease in the splenic blood pressure without ischemia due to collateral blood supply. The main complications of selective embolization are continuous bleeding, splenic infarcts and splenic abscesses. The main complications of observation alone are continuous bleeding and formation of splenic pseudoaneurysms. Our aim was to assess the efficacy of PSAE in the cessation of bleeding without formation of pseudoaneurysms, and the outcome of the spleen after such intervention. Methods:   A prospective observational study of all patients undergoing PSAE for traumatic splenic injury in our institution over a 33-month period. Clinical and Doppler sonographic examinations were performed to assess cessation of bleeding, splenic blood flow, and formation of splenic pseudoaneurysms, infarcts or abscesses. Results:   During 33 months, 11 patients with blunt abdominal trauma and tomographic evidence of either high grade or actively bleeding splenic injuries were treated by PSAE. During follow-up, no patient underwent surgery or repeated embolization. Preserved blood flow was found on Doppler sonography in 82% of the patients and no pseudoaneurysms were demonstrated. A perisplenic collection was found in one patient and responded well to percutaneous drainage. Conclusions:   Proximal embolization of the splenic artery for severe splenic injury is highly successful in cessation of bleeding while preserving splenic architecture. There were minimal complications in this series demonstrated by clinical and Doppler examinations.  相似文献   

12.
Terminal liver cirrhosis is associated with marked severe portal hypertension, which increases the risk of intraoperative hemorrhage and graft hyper-perfusion, especially, in small-for-size graft. In cases with developed collateral vessels, we often face difficulties in perihepatic dissection with blood stanching against bleeding during recipient hepatectomy. For aseptic preoperative portal decompression, we established the proximal splenic artery embolization (PSAE) technique. Sixty adult living donor liver transplantation recipients with viral/alcoholic hepatic failure were divided into two groups; PSAE group (n = 30) and non-PSAE (n = 30). In the PSAE group, the splenic artery was embolized proximal to the splenic hilum 12-18 h before surgery. PSAE enabled shortening of operating time, reduced blood loss, led to less need for transfusion, and significantly reduced the post-transplant portal venous velocity and ascites. PSAE was not associated with complications, e.g., splenic infarction, abscess, or portal thrombosis. Six of the non-PSAE patients required additional surgical intervention to resolve postoperative hemorrhage and three patients required secondary PSAE for arterial-steal-syndrome. The hospital mortality rate of PSAE patients (3.3%) was significantly better than that of the PSAE group (13.3%, P < 0.05). Preoperative noninvasive PSAE makes more efficient use of portal decompression; thus, it can potentially contribute to improvement of outcome.  相似文献   

13.
脾动脉瘤7例诊治分析   总被引:3,自引:0,他引:3       下载免费PDF全文
目的:探讨脾动脉瘤的诊断和手术治疗方法。方法:回顾性分析7 例脾动脉瘤患者的临床资料。结果:6例经彩色多普勒超声(B超)初步诊断;4例经CT动脉造影(CTA),2例经数字减影血管造影术(DSA),1例经磁共振造影(MRA)确诊;无1例依靠临床症状而确诊。单纯脾动脉瘤切除术1例,脾动脉瘤加脾脏切除术1例,脾动脉瘤切除加动脉重建术1例,动脉瘤近远端脾动脉结扎术1例,脾动脉瘤栓塞术2例,脾动脉瘤栓塞术加脾切除术1例。随访2个月至3年。无死亡及严重并发症病例。结论:脾动脉瘤依赖临床表现难以诊断,B超有筛选价值,CTA,MRA,DSA均有诊断价值。一旦确诊应尽早选择腔内介入栓塞治疗或手术方法。  相似文献   

14.
目的探讨脾动脉分支血管直径比值法计算脾脏栓塞体积的临床应用价值。方法回顾性分析20例接受部分脾动脉栓塞术治疗的肝硬化合并脾功能亢进患者的资料。根据术中脾动脉的血管造影图像,测量脾动脉分支血管的直径并计算脾脏栓塞体积百分比。对所有患者均于术后1个月行增强CT检查,并基于VR重建图像计算脾脏栓塞体积百分比。观察术后并发症及不良反应情况,于术前3天、术后1周、1个月、3个月检测外周血红细胞、白细胞及血小板,并进行统计学分析。结果部分脾动脉栓塞术中采用脾动脉分支血管直径比值法计算脾脏栓塞体积百分比[(52.15±3.29)%]与术后1个月CT测量栓塞体积百分比[(49.99±6.02)%]差异无统计学意义(t=-1.630,P=0.120)。所有患者术后均出现中度或中度以下左上腹疼痛,并出现恶心、呕吐、发热症状,均经对症治疗后好转。术前3天、术后1周、1个月、3个月外周血外周血红细胞、白细胞及血小板差异均有统计学意义(P均0.001)。结论部分脾动脉栓塞术中应用脾动脉分支血管直径比值法评估脾脏栓塞体积,简便、实时且较为准确,值得临床推广应用。  相似文献   

15.
目的总结外伤性脾破裂非手术治疗的经验。方法对1998年1月至2008年12月期间153例外伤性脾破裂采用非手术治疗的临床资料作回顾性分析。结果153例接受非手术治疗中,145例避免手术治疗,成功率达94.8%;其中,Ⅰ级脾破裂成功率98.0%(96/98),Ⅱ级脾破裂成功率89.1%(49/55);Ⅰ级2例、Ⅱ级6例因血流动力学紊乱转手术治疗。153例均痊愈出院。结论只要采用个体化选择,综合考虑血流动力学、影像学分级、腹腔积液、腹腔合并伤以及年龄等因素,大多数I级和Ⅱ级外伤性脾破裂者均能避免手术治疗。  相似文献   

16.
BackgroundNon-operative management (NOM) is accepted treatment of splenic injury, but this may fail leading to splenectomy. Splenic artery embolization (SAE) may improve rate of salvage. The purpose is to determine the cost-utility of the addition of SAE for high-grade splenic injuries.MethodsA cost-utility analysis was developed to compared NOM to SAE in patients with blunt splenic injury. Sensitivity analysis was completed to account for uncertainty. Utility outcome was quality-adjusted life years (QALY).ResultsFor patients with grade III, IV and V injury NOM is the dominant strategy. The probability of NOM being the more cost-effective strategy is 87.5% in patients with grade V splenic injury. SAE is not the favored strategy unless the probability of failure of NOM is greater than 70.0%.ConclusionFor grade III–V injuries, NOM without SAE yields more quality-adjusted life years. NOM without SAE is the most cost-effective strategy for high-grade splenic injuries.  相似文献   

17.
A 12-year-old girl was admitted after a bicycle accident, and a grade 4 splenic injury was diagnosed. She became hemodynamically unstable within the first hours after arrival and remained so despite fluid resuscitation and transfusions. As an alternative to laparotomy, splenic artery embolization was performed. The patient had an uneventful recovery without the need for further transfusions. Nonoperative management of blunt splenic trauma remains the gold standard in pediatric trauma care. In hemodynamically unstable patients, splenic artery embolization should be considered as an adjunct to that strategy.  相似文献   

18.
CT检查在外伤性脾破裂诊断和治疗中的应用价值   总被引:3,自引:0,他引:3  
目的 探讨CT扫描对脾破裂诊断与治疗临床价值。方法回顾分析我院1998~2008年收治83例经CT和B超检查的外伤性脾破裂的临床资料。结果根据CT表现进行脾损伤分成四级:Ⅰ级,包膜下积血9例;Ⅱ级,脾外周撕裂23例;Ⅲ级,脾实质撕裂29例;Ⅳ级,粉碎性脾12例,其中Ⅰ级和部分Ⅱ级病例行保守治疗22例.部分Ⅱ级及Ⅲ级以上行手术治疗61例.均治愈出院。术前CT扫描诊断符合率93.5%,B超诊断符合率82.0%:CT扫描发现8种合并伤共29例,B超发现3种合并伤7例。结论CT检查可对外伤性脾破裂进行正确的诊断,并对脾破裂治疗方法的选择具有指导意义.是外伤性脾破裂最重要的检查方法之一。  相似文献   

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