延迟性脾破裂12例诊治分析

目的:探讨延迟性脾破裂的发病机制及诊治方法.方法:对 2000～ 2004年 5月收治的 12例延迟性脾破裂进行回顾 性分析.结果: 12例均有左侧胸、腹部外伤史,且伤后均有左上腹轻微胀痛或轻度压痛,入院时均有突然发生左上腹 剧痛. 8例(66.7%)伤后两次腹痛间有明显缓解期, 10例(83.3%)延迟性脾破裂发生于伤后 2周内, 4例于伤后腹 内压增加时突发左上腹剧痛;术中发现脾包膜下血肿破裂 7例(58.3%);行脾切除 10例(83.3%).脾部分切除及脾 修补各一例.全组无死亡.结论:延迟性脾破裂多发生于左侧胸、腹部外伤后 2周内,多伴有左上腹的胀痛和左上腹 的压痛,腹痛常有中间缓解期,腹压增加时可突发上腹部剧烈疼痛,它以脾包膜下血肿破裂最为多见,早期诊断困难, 诊断的关键是要有高度的警惕性.治疗以脾切除为主.

Analysis of the diagnosis and treatment of 12 cases of celayded splenic rupture

Objective To explore ways of diagnosis and treatment of delayed splenie rupture. Methods To retrospectively analyse 12 cases of delayed splenic rupture from 2000 to 2004. Result All of the 12 cases complained of swollen pain or mild tenderness in left upper abdomen;8 cases (66.7%) have a distinct remission stage between two episodes of abdominal pain after injury;10 cases (83.3%) have ruptured spleen within 2 weeks after injury;4 cases complained of sudden severe pain in left upper abdomen when abdominal pressure increased after injury;7 cases were found intraoperatively to have subcapsular hematoma;10 cases (83.3%) underwent spplenectomy.No one died in the group. Conclusion Most cases of delayed splenic rupture occur within 2 weeks after thorax,abdomen trauma,often accompanied by swollen pain and tenderness in left upper abdomen. There often exists a remission stage between two attacks of abdominal pain. Sudden severe pain can occur in left upper abdomen when abdominal pressure increases,mostly as a result of ruptured splenic subcapsular hematoma. Early diagnosis is difficult. Sharpened vigilance is the key to diagnosis. Splenectomy is the main way of therapy.