胎,婴儿脾的外形与脾叶动脉分布的关系

观察研究了７９例胎、婴儿的脾。在描记脾外形的基础上，求出以脾的最大投影面积与其重的回归方程；记录分析了脾切迹、裂及其与脾内叶、段动脉分布的关系；在３１例胎儿脾透明标本上分离了上、下叶和极段，测算结果主要有：上叶大于下叶者占５８．１％，而上叶小于或等于下叶者分别占２５．８％和１６％，极段一般小于脾大小的１／４。     

脾动脉侧支循环研究与保留性脾手术的应用

随着人们对脾脏免疫功能的认识,兴起了保留性脾手术。但是,脾内部血管缺乏稳定性,对脾部分切除如何解决术中出血问题产生很大难度。为此笔者对脾动脉侧支循环进行了研究。发现结扎脾动脉主干后,脾仍然可通过侧支有一定量血液供应,为脾部分切除如何解决术中出血问题,提供了新的手术根据。     

人脾血管吻合的研究

用ＡＢＳ铸型的方法对５０例胎儿和新生儿脾内，外血管吻合进行了观察，结果：（１）脾存在较为广泛的血管血合，共发现２７例４８处静脉属支间的吻合，３１例５１例处脾支间的吻合。（２）静脉间的吻合多位于上、下极附近，叶、段间的吻合少且细弱。动脉间的吻合多位于脾门和上极附近，近半数的吻合位于叶间或段间，故在脾叶、段切除时应慎重。（３）脾外吻合多为短交通支形，弓形吻合绝大部分位于脾内，汇集形动脉吻合多存在于叶间     

脾形态,脾动脉支及脾段的观察

观察经常规固定的100例成人脾,形态可分五型。共出现312个脾切迹,平均每个脾3.12(0～9)个。位于脾前缘切迹的延长线通过脾无血管区者162(60.67％)个。脾动脉主干远距分支(分支点距脾门21mm以上)82例,近距分支(20mm以下)12例,不分支者6例。脾穿动脉共出现685支,平均6.85(2-12)支,其中以6、7、8支者多见。80例剥制脾结构观察,脾叶、脾段和无血管区排列分明者59例(73.7596)。脾段呈3～7个,其中4段脾最多见为34例(57.63％)。典型两叶四段脾31例。A、B、C三条假设线通过无血管区以B线最高,达80.25％,在两叶四段脾中B线通过无血管区高达90.32％。根据脾形态结构,本文对脾部分切除术提出一些建议。     

脾外伤手术的局解浅析

我院自１９９４年１２月至１９９７年２月共收治脾外伤性破裂２７例。根据脾脏的脾叶动脉，脾段动脉的分型，以及脾损伤情况，而分别采取脾叶、段切除术，脾修补术，脾切除术。从中发现脾的损伤与脾脏的局部解剖有关，同时脾门的脾叶动、脾段动脉的解剖分型对手术方法的选择有指导意义 。     

胰体尾段脾动脉结扎脾修补术14例分析

目的 探讨远离脾门结扎脾动脉后脾修补术治疗脾破裂。方法 剪开胃结肠韧带,有胰体尾后上方找到脾动脉后结扎,保留胃短动脉和胃网膜左动脉对脾脏的供血,并缝合脾裂口。结果 １４例中１例出现脾坏死,其余１３例保脾成功。结论 远离脾门结扎脾动脉主干后缝合修补,保脾效果良好。     

部分性脾栓塞术的解剖学

目的:为部分性脾栓塞术提供解剖学基础。方法:16例脾动脉铸型标本,观察脾动脉的脾支和胰尾动脉。结果:(1)脾内径1 mm的动脉支数为20(18-33)支,源自上、下脾叶动脉的支数大致相等,其比例为9:9-16:17,上、下叶间存在无血管区; (2)胰尾动脉大多发自下叶支,起始处内径为1.14(1.12-1.22)mm。结论:在超选择性插管基础上实施部分性脾栓塞术,可将脾栓塞程度控制在50%左右。超选择性插管和使用2 mm×2mm×2 mm明胶颗粒可避免误栓胰尾动脉。     

保留胃短动脉的保脾手术3例

近年许多文献强调对外伤性脾破裂应尽量采用保留全睥或部分脾组织的保守手术．以保留脾功能。我科自1990年4月～1996年8月共收治外伤性脾破裂102例．采用单纯缝合或部分切除保留脾手术18例。其中采用保留胃短动脉的保留脾手术3例，效果较好现报道如下：     

胎儿脾动脉（脾外部分）的解剖学观察

本文用30例胎尸,经灌注后进行解剖剥离.在手术放大镜下进行观察,并对脾动脉的分支及侧支循环进行了观察,其结果如下.(1)脾动脉均起于腹腔干并沿胰腺上缘走行,脾动脉发出胰腺支,胃短动脉,胃网膜左动脉,胃后壁动脉,脾叶动脉和脾极动脉.(2)脾动脉的侧支循环十分丰富,脾动脉与胃左动脉,左膈下动脉,胃网膜右动脉,肠系膜上动脉,胰动脉等均有侧支吻合,并且胃网膜左动脉与胃网膜右动脉吻合形成网膜弓.     

脾动脉栓塞治疗外伤性脾破裂的临床应用

目的探讨脾动脉栓塞治疗外伤性脾破裂的临床疗效及应用价值。 方法穿刺股动脉,行脾动脉造影后行脾动脉栓塞,治疗外伤性脾破裂6例。 结果6例患者术后均出现左上腹不同程度胀痛,术后均出现发热,最高体温38.5 ℃,5例患者出现少量胸腔积液。6例患者术后均未再出现出血,保脾成功,顺利出院。 结论在病情允许情况下,脾动脉栓塞治疗外伤性脾破裂止血效果确切,有效保留脾脏免疫功能,且患者创伤小,恢复快。     

Splenic injury following trauma: the role of ultrasonography

The spleen is the most commonly injured abdominal organ and this may follow accidental or non-accidental trauma. Three cases are presented of adult males who presented with pain in the left hypochondrium following trauma. Traumatic injury to the spleen was suspected and ultrasound confirmed this suspicion in the 3 patients. The patients did well after splenectomy. Hence ultrasound evaluation of patents with history of trauma and left hypochondrial pain should be performed urgently in order to detect possible splenic rupture.     

IgG-mediated phagocytosis in regenerated splenic tissue.

The risk of severe infections after splenectomy is well established. Operations such as auto-transplantation, splenic artery ligation or partial resection have been advocated for the retention or regeneration of splenic tissue following splenic trauma. The potential of such tissue to protect from infection is unclear. The ability of splenic tissue to phagocytose IgG opsonized syngeneic erythrocytes was measured in rats 6 months following splenectomy and splenic autotransplantation, splenic artery ligation, total or partial splenectomy, and compared with eusplenic controls. In eusplenic and partially splenectomized rats 71% of the label was cleared at 3 h, compared with approximately 50% in rats following total splenectomy, splenectomy and splenic autotransplantation or splenic artery ligation. The autotransplanted and the ligated splenic tissue cleared less than 10% compared with control spleen, but there was no difference between them when clearance was expressed as uptake per gram of tissue. Splenic autotransplants and ligated spleens were small and histologically abnormal, with an increase in the red pulp, significantly less white pulp and marginal zone, and the frequent absence of a central arteriole in the white pulp. The clearance of label was proportional to the amount of red pulp in the tissue, although the red pulp from the regenerated tissues was not as efficient at phagocytosis as control red pulp. The tissue which regenerated following autotransplantation or splenic artery ligation did not result in greater clearance of erythrocytes from the circulation than that which occurred in splenectomized rats.     

Clinical application value of preoperative selective partial splenic embolization before splenectomy plus portal-azygous disconnection

The aim of this study is to explore the clinical application value of preoperative selective partial splenic embolization before splenectomy plus portal-azygous disconnection. 158 cases of liver cirrhosis combined with upper gastrointestinal hemorrhage patients were selected, which were randomly divided into splenic embolization group (S, n=77) and the non-splenic embolization group (U, n=81). Group S patients were firstly performed partial splenic embolization (PSE), and then underwent splenectomy plus portal-azygous disconnection, and the group U patients were directly performed splenectomy plus portal-azygous disconnection. Statistical analysis was used SAS8.0 statistical analysis software. One week after partial splenic embolization, the platelet of group S returned to normal, and the rise of white blood cells and hemoglobin, and shorten of prothrombin time in group S were much better than that in group U (P<0.01, P<0.05); the indexes, such as the intraoperative blood loss, the blood transfusion amount, the amount of platelet infusion, and the incidence of complications in group S were more superior than that in group U (P<0.05). Preoperative selective splenic artery embolization before splenectomy plus portal-azygous disconnection can restore the spleen function, and reduce the risk of surgery and incidence of complications.     

Vascular anatomy of the spleen: The basis for organ-preserving surgery

The increased susceptibility to infection following splenectomy calls for a partial organ-preserving operative procedure. The basis for this conservative surgery depends on a thorough knowledge of the vascular anatomy of the organ. With this in mind 32 spleens were studied by angiographies and corrosion casts. The organs were classified into four groups according to their vascular pattern with special emphasis on the blood supply of the polar segments. Two, three, and four segments were found in 3.1%, 15.6%, and 81.3%, respectively. A bifurcation of the splenic artery was noted in 93.8%, and a trifurcation in 6.2%. A Y-type of branching of the hilar vessels with easier access for surgical procedures was noticed in 84.4%, and a T-type in 9.4%; in 6.2% a classification was not possible. Intersegmentary anastomoses, as a potential hazard for operations on the spleen, were present in 15.6%. Arteries and veins coincided. The exact diagnosis of the specific individual vascular anatomy and segmental organization of the spleen are necessary presuppositions for a successful partial spleen-preserving technique. © 1993 Wiley-Liss, Inc.     

Critical mass of splenic autotransplant needed for the development of phagocytic activity in rats

When total splenectomy is inevitable, heterotopic splenic autotransplantation seems to be the only alternative to maintain the functions of the spleen. The present study was carried out to analyse the critical mass of splenic autotransplant (SAT) for the development of phagocytic activity in rats. Wistar rats were submitted to total splenectomy (TS) alone or in combination with slices of SAT ranging from an average rate of 21·9% (one slice) to 100% (five slices) of the total splenic mass implanted into the greater omentum. Sixteen weeks after the beginning of the experiment, the animals were inoculated intravenously with a suspension of Escherichia coli labelled with Tc‐99m. After 20 min, the rats were killed and the liver, lung and spleen or SAT, as well as blood samples were removed to determine the percentage of labelled bacteria uptake in these tissues. As the percentage of the total splenic mass contained in the SAT increased, the bacteria remaining in the blood decreased. From the implant of 26% up to the implant of the total splenic mass (100%) there was no difference in the bacteria remaining in the blood between the healthy animals of the control group and those submitted to TS combined with SAT. This finding shows that the critical mass needed for the development of phagocytic activity of macrophages in splenic autotransplants in adult rats is 26% of the total splenic mass.     

大网膜内植入自体脾组织与原位脾组织的结构比较

目的 :为临床应用自体脾组织植入术提供实验研究资料。方法 :大鼠分为实验组和对照组 ,前者切取 1 /2脾脏去包膜后切成 1mm× 1mm× 1mm大小均匀组织块 ,植入大网膜囊袋内。饲养 6个月后取 2组脾组织制片 ,光镜和电镜定性观察组织结构变化 ,计算机图像分析系统比较血管、红髓、白髓及胶原纤维的面密度 ;免疫组化法结合计算机图像分析测定神经肽 (NPY)阳性神经纤维密度。结果 :神经和边缘窦内皮细胞结构恢复较好 ,血管 ,白髓的面密度值较对照组减少 ,红髓与对照组相当 ,胶原纤维面密度增加。结论 :大网膜内植入的自体脾组织通过再生能恢复脾脏的主要组织结构 ,但不能完全恢复正常。     

Splenic reticuloendothelial function after splenectomy, spleen repair, and spleen autotransplantation

Overwhelming infection after splenectomy remains a problem despite the introduction of vaccine and antimicrobial prophylaxis. To evaluate prospectively various procedures proposed for salvage of the spleen, we measured reticuloendothelial function for two to five years in 51 patients who had initially presented with abdominal trauma and suspected splenic rupture. The mean percentage of pocked erythrocytes and the clearance of antibody-coated autologous erythrocytes in 8 patients who had splenic repair and in 6 who had partial splenectomy were the same as in 11 controls with intraabdominal injury that did not involve the spleen. The mean percentage of pocked erythrocytes remained significantly elevated in 19 patients who had undergone total splenectomy without autotransplantation of splenic tissue. One of seven patients who underwent splenic autotransplantation had a normal level of pocked erythrocytes 18 months after surgery, and a second patient had only a slight elevation at 24 months. The mean (+/- SEM) half-time clearance of labeled erythrocytes was significantly longer in the group that had total splenectomy without autotransplantation (421.1 +/- 74.5 hours) than in the autotransplantation group (91.6 +/- 20.0) or in the controls (5.4 +/- 2.0). We conclude that reticuloendothelial function was better preserved after partial splenectomy and splenic repair than after splenic autotransplantation, but that autotransplantation was superior to total splenectomy and appeared to be safe. Splenic autotransplantation deserves further study in patients who have had splenic trauma when other surgical maneuvers to save the spleen are not possible.