脾切除781例临床分析

目的]探讨临床脾切除适应证的合理选择,围术期处理以及脾切除对机体的影响.方法]对我院近10年781例脾切除患者的临床资料进行回顾性统计分析和部分病例的术后随访.结果]切脾指征中以门静脉高压性病理脾最为多见(321例,41.10%),其次为腹部肿瘤联合脾切除(213例,29.32%);781例患者中共行1 373例次不同类型的手术,联合手术中以分流或断流术最多(23.65%);术后共有113人(14.47%)发生202例次并发症,发生率为25.86%,以感染最为多见.对120例门脉高压巨脾切除后进行了1～10年的随访,未见有严重感染发生.结论]门静脉高压性病理脾是我国脾切除主要适应证,且病理脾的切除对术后远期疗效是有益的;术后并发症的发生与切脾指征密切相关,加强围术期处理是提高近期疗效的关键.

Clinical Analysis of 781 Patients Underwent Splenectomy

Objective] To summarize the indications of splenectomy and evaluate the perioperative management and investigate the clinical effects of splenectomy. Method] The clinical data and follow-up information of splenectomy of 781 cases from our hospital in recent 10 years were analyzed retrospectively. Results] Most patients were portal hypertension splenomegaly (n=321, 41.10%). The next were synchronous tumors resection with splenectomy (n=213, 29.32%). Different types of operations were performed for 781 patients (total 1373 times), most of which were shunt or divascularization (23.65%). Two hundreds and two times (25.86%) of complications developed in 113 patients (14.47%), most of which were infections. One hundred and twenty patients with portal hypertension splenomegaly were followed up for 1-10 years, and no serious infection occurred. Conclusion] Portal hypertension splenomegaly is the main indication of splenectomy in our country and the splenomegaly resection is beneficial for long-term outcome. Postoperative complications are critically related to the spleneetomy indications and a careful perioperative management is very important.