外伤性延迟性脾破裂的诊治探讨(附17例报道)

目的：探讨外伤性延迟性脾破裂的发病规律、临床特点、诊断和治疗方法。方法：结合国内外资料及本组病例进行回顾分析。结果：明确诊断13例，误诊为肝破裂1例，腹膜后血肿1例，肾挫裂伤1例，宫外孕破裂1例。16例手术治疗，1例非手术治疗。行脾切除术10例，其中保留副脾1例，脾切除加自体脾组织网膜内移植术1例，脾缝合修补术3例；脾部分切除术3例。治愈16例，死亡1例。结论：本病由于腹腔内出血与受伤时间间隔长，容易误诊。诊断除依靠病史、临床表现外，应及时进行腹腔穿刺、B超及CT检查。治疗以脾切除为主，可根据病情、脾破裂的程度以及是否有合并伤等情况采取保脾手术或非手术治疗。

Diagnosis and Treatment of Traumatic Delayed Rupture of Spleen(a Report of 17 Cases)

Objective: To study the diagnosis and treatment of traumatic delayed rupture of spleen. Methods: Clinical data of 17 patients with traumatic delayed rupture of spleen were retrospectively analysed. Results- Preoperative diagnosis of 13 patients were clear-out,misdi-agnosis was as rupture of liver for 1 patient, as post-peritonem hematoma for 1 patient,as Kidney contusion for 1 patient,as ectopic pregnancy for 1 patient. 16 cases underwent operation, 1 patient was treated without surgery. Of the 16 patients who had surgery, 10 patients had splenectomy,1 case reserved accessory spleen, 1 case had splenectomy pulsing self splenosis into omentum; 3 patients had spleen sutured; 3 patients had spleen partial splenectomy. 16 patients were cured, 1 patient died. Conclusion: The disease is easily to misdiagnosis owing to a long time lag between the injury and intraabdominal hemorrhage. Besides the history and clinical manitestation, peritoneal puncture, sonograpby computed tomography were needed to make a diagnosis. Splenectomy is a primary way for treatment, but operative preservation of the spleen and nonsurgery should be considered according to the state of illness,degree of the rupture of spleen.