胃癌根治术中的医源性脾损伤防治

目的 探讨胃癌根治术中医源性脾损伤防治方法。方法回顾性分析本科5年来420例胃癌根治术中出现14例医源性脾损伤的临床资料。结果根治性远端胃大部切除、近端胃大部切除和全胃切除中，分别发生脾损伤8例、4例、2例。脾损伤按Pachter分级，Ⅰ级3例、Ⅱ级9例、Ⅲ级2例。经电凝加医用生物蛋白胶止血、大网膜缝合、明胶海绵压迫止血3例，缝合修补术9例，全脾切除2例。全组均痊愈出院。结论胃癌根治术导致的医源性脾损伤的发生，与术式相关，通过提高认识、改进操作、妥善处理，这种损伤是可以预防或降到最低限度的。

Methods in prevention and treatment of iatrogenic splenic injury during radical gastrectomy

Objective To investigate the methods in prevention and treatment of iatrogenic splenic injury in radical gastreetomy. Methods A retrospective clinical data analysis of 14 iatrogenic splenic injury patients from 420 radical gastrectomy cases in the past 5 years in our hospital. Results There were 8,4, and 2 splenic injury cases in radical distal subtotal gastrectomy, proximal gastreetomy and total gastrectomy, respectively. According to Pachter grade, 3 cases belonged to grade Ⅰ, 9 cases belonged to grade If, 2 case grade Ⅲ/. Eelectrocoagulation plus fibrin glue, omental suture, gelatin sponge compression hemostasis were used in 3 cases to stop bleeding, 9 patients received suture neoplasty, 2 cases received full - splenectomy. All of the 15 cases were discharged from hospital with fully recovery. Conclusion latrogenic splenic injury caused by radical surgery of gastric cancer is related to type of operation, and can be prevented or reduced by raising our awareness and improving the operation.