脾切除对小鼠腹腔巨噬细胞数量和功能的影响

目的：研究脾切除对小鼠腹腔巨噬细胞数量和功能活性的影响。方法：术后4周获取腹腔常居巨噬细胞和炎症巨噬细胞,检测其数量、吞噬功能和一氧化氨水平。结果：与正常对照组和假手术组比较,脾切除组小鼠的2种巨噬细胞不仅数量明显减少,而且它们的吞噬功能和一氧化氮水平呈明显下降。结论：提示脾切除造成的单核吞噬细胞继发性炎症反应的捐伤和巨噬细胞功能活性的降低,可能是脾切除后(凶险性)感染的重要因素。     

淋巴细胞亚群和NK细胞在脾切除术前后的动态变化

目的研究脾切除术对T细胞亚群和自然杀伤细胞(NK细胞)免疫功能的影响.方法将所收集的30例脾切除患者和30例其它腹部手术患者分为实验组和对照组.比较两组患者手术前和术后7天的T淋巴细胞亚群和(NK)活性以及免疫功能的变化.结果术后7d实验组的CD3、CD4/CD8比值和NK细胞明显低于对照组(P＜0.05),其中,CD3、CD4、CD4/CD8、NK细胞的术前术后下降程度较对照组更加明显(P＜0.01).CD8水平则无统计学意义(P＞0.05).结论脾切除术后早期细胞免疫功能严重受损,对脾破裂或良性肿瘤患者的外科治疗有指导意义.     

脾切除对大鼠血浆及肝肺组织中内毒素廓清的影响

目的 观察脾切除对血浆中内毒素清除的影响及内毒素在主要脏器的分布特征,探索脾切除后上反应与组织损害的发生机制。方法 雄性Ｗｉｓｔａｒ大鼠１１２只,随机分为有脾组（ｎ＝５６,行大网膜切除术,保留脾脏）、脾切除组（ｎ＝５６,行脾切除术）。术后１周静脉注射内毒素０．１ｍｇ／ｋｇ,分别于注射前、注射后１０ｍｉｎ、０．５、１．５、４、１２、２４ｈ活杀动物,测定血浆和肝、肺组织内毒素水平,同时检测肝、肺脏器功     

医源性脾损伤28例诊治分析

目的 分析医源性脾损伤的原因及有关的治疗手段。方法 回顾分析28例脾损伤和有关文献报道的病例。结果 脾损伤与胃十二指肠溃疡、胃癌、食管癌、肝肿瘤手术等有关；心肺复苏和纤维结肠镜检查也可致脾损伤；自发性脾破裂可发生在白血病等疾病的发病过程中。结论 根据损伤原因及损伤分级不同，采取不同的治疗方式。可提高保脾手术成功率。     

HELLP syndrome in a pregnant patient with a past history of splenectomy for idiopathic thrombocytopenic purpura. Case report

Case: We present a case of HELLP syndrome occuring in a patient who at the age of 8 years had undergone a splenectomy for idiopathic thrombocytopenic purpura. She was diagnosed as having HELLP syndrome 37 weeks of gestation and had a cesarean section. Received: 4 June 1996 / Accepted: 7 October 1996     

腹腔镜脾下切除术

介绍腹腔镜脾切除术发展概况、手术适应症、手术方法、优缺点和并发症的防治.腹腔镜脾切除术创伤小、对机体影响少、痛苦轻和恢复快,适用于有脾切除指征的各种脾疾病.     

Wandering spleen with splenic torsion: Report of two cases

Introduction and importanceAnatomical variation of the spleen’s position in the abdomen, is a rare condition called Wandering Spleen (WS). WS is a vital differential diagnosis in patients presenting with acute abdomen and diagnosis should be made promptly to prevent development of serious complications.Case presentationIn this article, we report two cases of WS (27 and 20 years old females) presenting with abdominal pain due to splenic torsion. Both Patients underwent splenectomy and discharged with no further complications.Clinical discussionThe presentation of a wandering spleen varies from an asymptomatic mass to an acute abdomen due to torsion and splenic infarction, therefore recognition of this condition can be challenging. Diagnosis depends on imaging studies, and treatment options consist of performing either splenectomy or splenopexy.ConclusionConcerning the high incidence of splenic torsion and infarction in WS patients, early recognition of this condition and initiation of apt intervention is of great significance.     

Minimally invasive splenectomy in grade IV splenic trauma: A case report associated with high-grade renal trauma

Introduction and importanceIn closed abdominal trauma, the spleen is the most frequently injured organ (30–45%). Splenic lesions grades IV-V have higher failure rates with nonoperative management (NOM). The minimally invasive approach is an alternative when NOM fails. This is the first reported case of a patient with splenic and left renal trauma, both grade IV, with combined management, which consisted of a minimally invasive surgical resolution of the splenic trauma and a conservative management of the renal trauma, with a satisfactory recovery of the patient. This contributes to understanding the benefits of minimally invasive surgery in moderate splenic trauma associated with other high-grade injuries.Case presentationWe present a 45-year-old woman with a multiple trauma after a motorbike vs car traffic accident. On physical examination, she was hemodynamically stable, with abdominal guarding and generalized rebound tenderness associated with multiple upper and lower limb fractures. An abdominal CT scan revealed grade IV splenic and left renal trauma, with moderate hemoperitoneum. A minimally invasive laparoscopic approach for hemoperitoneum drainage and splenectomy was performed.Clinical discussionThere is currently no consensus to define the indications for minimally invasive treatment on splenic trauma. While laparotomy is the standard treatment, it is not without potential severe complications, while laparoscopy providing a treatment option in selected cases with hemodynamic stability.ConclusionThe role of the minimally invasive approach is safe and feasible in selected patients with high-grade splenic lesions and hemodynamic stability, including the association with other organic lesions such as kidney trauma.     

联合肝脾切除在原发性肝癌合并肝硬化和脾功能亢进患者中的应用

目的:探讨原发性肝癌合并肝硬化脾功能亢进患者行肝癌切除联合脾切除的临床疗效。方法:报告2009年1月至2014年10月18例肝癌合并肝硬化、脾功能亢进患者采用肝脏肿瘤切除同期行脾切除和(或)断流手术治疗的效果、并发症及随访情况。结果:总体并发症发生率为72.2%(13/18),围手术期死亡率为11.1%(2/18)。14例获得长期随访,随访时间12~36个月,中位随访时间为23个月,5例肿瘤复发,2例死亡。结论:联合肝脾切除和(或)断流手术,手术风险较大,应结合术前检查和术中探查情况,采取个体化的治疗方案,选择性地应用于肝癌合并肝硬化、脾功能亢进的患者。     

完全腹腔镜下肝癌及巨脾联合切除术的手术配合

目的探讨同步腹腔镜肝切除联合脾切除术治疗原发性肝癌并发肝硬化门静脉高压性脾功能亢进的手术护理配合。方法回顾性分析2015年1-4月扬州大学临床医学院收治的5例原发性肝癌合并肝硬化门静脉高压症和脾功能亢进患者的临床资料。5例患者施行同步腹腔镜肝切除联合脾切除术,术中行脾血自体回输。观察患者手术时间、术中出血量、术中输血量、术后进食时间、术后拔除引流管时间、术后住院时间及术后并发症发生情况。采用门诊和电话方式随访,随访时间截至2015年6月。正态分布的计量资料以(x—±s)表示。结果 5例患者中,3例施行了腹腔镜肝切除联合脾切除术,1例施行了腹腔镜肝切除加脾切除加胆囊切除术,1例施行了腹腔镜肝切除加脾切除加断流术,无1例中转开腹。患者手术时间为(225±41)min,术中出血量为(221±81)mL。2例患者术后发生腹腔积液,其中l例患者同时发生胸腔积液,均经保守治疗后症状消失。患者术后住院时间为(7.84±0.8)d,均顺利康复出院,无围术期死亡发生。5例患者均获得随访,截至随访时均生存。结论同步腹腔镜下肝切除联合脾切除术治疗原发性肝癌并发肝硬化门静脉高压性脾功能亢进安全可行,无需扩大腹壁切口,具有创伤小、并发症少、恢复快的特点。精湛的手术操作技术与娴熟的手术配合是该类手术成功的关键。