保脾手术治疗脾破裂27例临床分析

目的:探讨脾破裂保留脾脏手术方式选择。通过对27例脾破裂保留脾脏手术的回顾性分析。结果:全部病例行脾修补术14例,脾部分切除术8例,全脾切除体脾移植术5例,均痊愈。结论:脾破裂保留脾脏手术应先保命,后保脾。保留脾脏手术应根据损伤程度,合并伤情况,手术者的经验和条件,合理选择脾修补、部分切除、自体脾移植术,各种方式应灵活合理应用。     

腹腔镜治疗外伤性脾破裂51例报告

目的:总结腹腔镜手术治疗外伤性脾破裂的手术经验及临床价值。方法:回顾分析2004年1月至2013年12月为51例外伤性脾破裂患者行腹腔镜手术的临床资料。结果:31例行脾切除术(其中13例于脾脏切除后脾片自体移植),2例行脾部分切除并脾蒂血管选择性结扎,13例行脾脏修补术,5例中转开放手术。手术时间平均(126±32)min,其中腹腔镜脾切除术平均(94±21)min,脾修补术平均(150±13)min。术中探查腹腔积血量平均(560±457)ml,脾脏修补合并肝脏破裂的患者于术后2周下床,脾切除未合并肝肾挫伤的患者术后下床时间平均(1.5±0.2)d。术后肛门排气时间平均(2.0±1.3)d。2例脾切除患者术后当天出血,剖腹探查发现胃壁胃短动脉出血,缝扎后止血;1例脾静脉血栓经抗凝等治疗后缓解。患者均治愈出院,术后随访1年,未发现爆发性感染病例。结论:腹腔镜治疗外伤性脾破裂是安全、可行的,但需要术前评估脾脏破裂及患者全身情况,并进行个体化治疗,必要时应果断中转开放手术。     

39例外伤性脾破裂临床诊治体会

目的总结外伤性脾破裂的诊治体会。方法回顾性分析39例外伤性脾破裂患者的临床资料。结果 39例外伤性脾破裂患者,非手术治疗13例,手术治疗26例,其中脾切除术15例,脾修补术6例,脾动脉结扎保脾手术5例,均治愈,无死亡病例。结论及时正确的诊断和选择适当治疗方法是提高外伤性脾破裂治愈率的关键。     

腹腔镜下脾修补术治疗外伤性脾破裂32例体会

目的 探讨腹腔镜脾修补术治疗Ⅰ～Ⅱ级脾破裂的适应证、临床效果及可行性.方法 回顾性总结2007年3月至2012年2月期间外伤性脾破裂行腹腔镜脾修补术32例患者临床资料.结果 32例患者经腹腔镜手术治疗,除其中5例中转开腹外,其它均治愈.结论 腹腔镜下脾修补术对于Ⅰ～Ⅱ级脾损伤具有良好的治疗效果,可以替代传统的开腹手术,具有保留脾脏功能、创伤小、痛苦轻、恢复快等优点.     

脾外伤的保脾治疗

目的:总结保脾治疗经验。方法:对1987～2000年间有选择的67例脾破裂行保脾治疗患者的临床资料进行分析。其中非手术治疗19例,手术治疗48例。单纯缝合修补21例;缝合+脾动脉结扎12例;脾部分切除8例;脾部分切除+脾修补7例。结果:1例修补术后继发出血,经保守治愈,余病例全部治愈。结论:正确掌握手术治疗指征及合理选择术式是保脾治疗成功的关键。     

外伤性脾破裂43例诊疗体会

目的探讨外伤性脾破裂的诊断和治疗方法。方法通过回顾分析43例外伤性脾破裂的临床资料,对外伤性脾破裂的临床诊断与治疗进行分析。结果外伤性脾破裂43例,均以外伤后腹痛为主要症状,彩超提示腹腔积液,均行诊断性腹腔穿刺,有40例抽出不凝血,以手术治疗为主;非手术治疗3例,手术治疗40例（脾修补术5例,脾全切加自体脾移植术13例,单纯脾切除术22例）,二次手术1例,治愈40例。结论外伤性脾破裂以腹痛为最先及主要临床表现,详细询问病史,仔细体检,完善血常规、腹部彩超、上腹部CT等检查,多部位反复腹穿能显著减少脾破裂漏诊或误诊率。外科手术治疗是主要的治疗方法,治疗外伤性脾破裂实行脾全切加自体脾组织移植术是基层医院的主要术式。及时抗休克治疗及选择合适的手术时机开腹手术能显著降低病死率。     

外伤性脾破裂126例诊断与治疗体会

目的:探讨脾脏外伤的治疗方法。方法:回顾性分析126例脾脏外伤的诊断及治疗。结果:108例手术治疗,其中行脾切除95例,脾修补3例,自体脾组织大网膜囊内移植10例。非手术治疗18例,均痊愈出院。结论:脾破裂一经诊断,原则上应紧急手术处理,因脾组织脆弱,破裂后不易止血、缝合或修补,故通常采用脾切除术。但对于轻度单纯破裂,可在严密观察下进行非手术治疗。近年来由于对人体免疫功能的研究日益深入,为避免脾切除术后出现暴发性感染,可根据脾脏损伤分级采取相应的保脾术。     

外伤性脾破裂保脾手术32例体会

目的　总结外伤性脾破裂 32例保脾手术的经验。方法　对我院 1990年～ 2 0 0 0年外伤性脾破裂 32例的资料进行回顾性分析。结果　单纯脾修补术 12例 ,不规则脾部分切除术 16例 ,规则性脾部分切除术 4例 ,均获得成功。结论　保脾应遵循“抢救生命第一 ,保留脾脏第二”的原则 ,对无合并伤的Ⅲ级以内的脾破裂行选择性保脾手术是可以达到临床治愈的。     

外伤性脾破裂66例临床分析

目的分析外伤性脾破裂的不同治疗方法。方法选取2017-01-2019-10间睢县人民医院收治的66例外伤性脾脏破裂患者。均依据患者的病情及脾破裂的分级采取相应的治疗方法。回顾性分析患者的临床资料。结果本组非手术治疗6例中,4例成功,1例因发现继续出血、1例因发现有肠破裂,均立即实施手术。62例(含2例非手术治疗中转手术患者)行手术的患者均获成功。其中单纯缝合修补14例,脾动脉结扎及脾部分切除术9例,脾脏切除术及脾片移植术39例。术后随访1 a,其间均未发生延迟性脾破裂、肺部感染、血栓栓塞性病变及凶险性感染等并发症。结论对外伤性脾破裂患者,应遵循"抢救生命第一、保脾第二"的原则,依据脾破裂的分级,制订科学合理的治疗方案。     

创伤性脾破裂的治疗策略

目的:探讨创伤性脾破裂合理的治疗方法。方法:对作者14年间收治的153例创伤性脾破裂的病例的临床 资料进行回顾性分析。结果:脾破裂的诊断主要依据外伤史,血流动力学不稳定,腹痛,腹腔穿刺的影像学检查,B超、CT检查判断脾外伤的准确性均接近90％。本组中有17例接受非手术治疗,12例治愈,5例中转手术;本组中共有141例接受手术治疗,其中96例行脾切除术,28例行脾修补术,17例行脾部分切除术。本组治愈149例,治愈率为97.4％,死亡4例,死亡原因与严重的合并伤有关。结论:脾破裂治疗方式的选择应根据病人的全身情况,脾破裂的具体伤情,救治医生的技术能力等综合考虑。Ⅰ～Ⅱ级脾破裂在病人全身情况稳定的情况下可考虑非手术治疗,较浅的脾脏实质裂伤和脾一极挫裂伤,可考虑保脾手术;在出血危机病人生命时,应首选脾切除。     

脾动脉结扎伴大网膜填塞保脾72例

目的探讨外伤性脾破裂既能控制伤脾出血、保留脾脏,又能保证脾脏生理功能的手术方式。方法对72例外伤性脾破裂采用脾动脉结扎及大网膜填塞脾破裂口缝合修补治疗。结果保脾组均获得成功,术后均未出现再出血,其中42例经1~5年随访,B超、CT扫描脾解剖形态未见异常。结论该手术方法操作简单,效果满意,是较理想的保脾手术方法。     

外伤性脾破裂保脾治疗的可行性及安全性分析

目的探讨外伤性脾破裂保脾治疗的可行性与安全性。方法对1998年7月至2005年7月收治的24例外伤性脾破裂患者,采用了保脾治疗:非手术保守治疗9例,保留脾手术15例,其中单纯粘合胶止血1例、单纯脾动脉结扎2例、单纯缝合修补3例、脾动脉结扎加脾修补4例、缝合修补加粘合胶止血2例、脾脏网兜捆扎术1例、脾部分切除术2例。结果在9例行非手术保守治疗中,有7例保守治疗成功,均痊愈出院,2例在保守治疗中转脾切除;15例保脾手术中2例因术后发生大出血而再次行脾切除术,其中1例抢救无效当时死亡。13例手术保脾成功,平均住院时间为13d。无其他合并症。结论外伤性脾破裂保脾治疗是可行的,但有一定风险,必须严格手术指征,手术方式依脾损伤分级或程度选择最佳术式,确保手术安全,术后应严密观察。     

43例外伤性脾破裂的治疗体会

目的总结外伤性破裂的治疗方法与经验。方法对我院1995～2004年12月外伤性脾破裂43例患者资料进行回顾性分析,其中40例患者进行剖腹探查,术中行脾修补术13例,脾部分切除术9例,全脾切除13例,脾切除加自体脾脏移植术5例,3例在严密观察下行保守治疗。结果2例脾破裂患者术后因合并颅脑损伤和严重复合伤死亡,41例患者痊愈出院。结论遵循“抢救生命第一,保留脾脏第二”的原则,根据脾损伤伤情及病人的全身情况去选择手术方式,分别施行脾修补术,部分脾切除术,全脾切除术,全脾切除术加自体脾片移植术。如果伤情允许术中尽量保留器官,对不能保脾的伤者可行脾片移植术以保术后病人有良好的免疫功能。     

自发性脾破裂18例报告

目的总结自发性脾破裂的诊治经验。方法对1987年7月～2004年12月收治的18例自发性脾破裂患者的临床资料进行回顾性分析。结果全组18例中,充血性脾肿大4例(3例肝炎后肝硬化,1例血吸虫性肝硬化),原发性脾恶性淋巴瘤2例,结肠癌及胰尾癌浸润脾脏各1例,慢性粒细胞性白血病1例,脾海绵状血管瘤1例,脾脏囊肿2例,不明原因脾肿大4例,正常脾脏2例。急诊脾切除术14例,其中联合胰尾癌切除1例,联合结肠癌切除、结肠造瘘术1例。非手术治疗4例,其中1例因发热持续不退,1例因脾周血肿增大、疼痛加重而中转脾切除术;脾包膜下出血2例经非手术治愈。本组治愈16例,死亡2例。结论病理性脾脏是自发性脾破裂的主要原因。脾切除术是治疗自发性脾破裂的主要手段。     

Atraumatic splenic rupture and infection-related glomerulonephritis in a patient with infected aortic aneurysm: A case report

IntroductionAtraumatic splenic rupture is very rare and the case is often difficult to determine. We report a case of atraumatic splenic rupture in a patient with an infected aortic aneurysm.Case presentationA 40-year-old man under evaluation and treatment for renal dysfunction presented with the sudden onset of epigastric pain. The patient had a previous history of aortic arch replacement for Stanford type B aortic dissection. Contrast-enhanced computed tomography revealed intraabdominal hemorrhaging around the spleen and intrasplenic extravasation of contrast medium, and atraumatic splenic rupture was diagnosed. The patient slipped into hemorrhagic shock, and emergency splenectomy was scheduled. The histopathological diagnosis was splenic rupture with splenic infarction. The patient became febrile on postoperative day 10. Repeat contrast-enhanced computed tomography revealed enlargement of a cystic aortic aneurysm that was present prior to splenectomy. Infected aortic aneurysm was suspected, which was confirmed following thoracic endovascular aortic repair performed on postoperative day 12.DiscussionWe consider that splenic rupture occurred following infected of the kidney and spleen by an infected aortic aneurysm.ConclusionInfection should be considered as a cause in patients with atraumatic splenic rupture.     

Splenic injuries secondary to colonoscopy:Rare but serious complication

BACKGROUND Colonoscopy is a safe and routine diagnostic and therapeutic procedure for evaluation of large bowel diseases.Most common procedure related complications include bleeding and perforation but rarely a splenic Injury.AIM To investigate the reason for colonoscopy,presentation of patient with spleen injury,types of injury,diagnosis,management and outcomes of patients METHODS A structured search on four databases was done and 45 articles with 68 patients were selected.The reason for colonoscopy,presentation of patient with spleen injury,types of injury,diagnosis,management and outcomes of patients were identified and analyzed using SPSS.RESULTS The mean age of the patients was 62.7 years with 64% females.Twenty two percent had a complete splenic rupture with colonoscopy while 63% had subcapsular hematoma,spleen laceration and spleen avulsion.The most common reason for colonoscopy was screening(46%) followed by diagnostic colonoscopy(28%).Eighty seven percent of patients presented with abdominal pain.Patients with spleen rupture mostly required splenectomy(47%),while minor spleen hematomas and lacerations were managed conservatively(38%).Six percent of the patients were managed with proximal splenic artery splenic embolization and4% were managed with laparoscopic repair.The overall mortality was 10% while77% had complete recovery.The reason of colonoscopy against presentation specifically,abdominal pain showed no statistical significance P = 0.69.The indication of colonoscopy had no significant impact on incidence of splenic injury(P = 0.89).Majority of the patients(47%) were managed with splenectomy while the rest were managed conservatively(P = 0.04).This association was moderately strong at a cramer's V test(0.34).The Fisher exact test showed a higher mortality with spleen rupture(P = 0.028).CONCLUSION Spleen rupture due to colonoscopy is a significant concern and is associated with high mortality.The management of the patients can be individualized based on clinical presentation.     

选择性保脾治疗脾外伤的体会

目的总结脾外伤患者行保脾治疗的经验。方法回顾性分析197例脾损伤治疗的临床资料。结果 197例选择性非手术治疗87例,选择性手术保脾治疗110例,其中粘合胶加大网膜填压修补28例,脾动脉结扎脾修补24例,脾部份切除26例,脾切除自体脾片移植22例,腹腔镜脾修补10例。手术治疗发生并发症17例,其中粘连性肠梗阻4例,脾热10例,胰漏2例,脑梗塞1例。全部治愈出院。结论外伤性脾破裂保脾治疗,较好的保持了脾脏功能,值得推广。     

基层医院外伤性脾破裂诊治特点——附72例分析

目的探讨外伤性脾破裂在基层医院的临床特点,指导临床诊治和提高疗效。方法对1995年至2005年10年间收治的72例外伤性脾破裂病例的临床资料进行回顾性分析。结果本组手术治疗64例,非手术治疗8例,全部治愈出院,术后无并发症。本组资料伤后到手术时间,与文献报道无明显差异;无死亡病例,全部治愈。结论根据脾损伤伤情,分别实施不同的脾手术方式,术中尽量保留脾脏及其功能。在掌握适应征的前提下行保守治疗也是治疗脾外伤的一种方法。     

Should the injured spleen be preserved?

Splenectomy is primarily followed by reduced defence against infection due to encapsulated bacteria, such as pneumococci. Organ preservation, therefore, has been emphasised in the treatment of traumatic rupture of the spleen, especially when it comes to patients in childhood. There are several practicable approaches to orthotopic preservation of the spleen, including conservative treatment of patients for smallest ruptures under stringent clinical control and, even more, fibrin sealing. Growth in accurate knowledge of the segmental structure of the spleen have enabled partial removal of the organ along the poorly vascularised intersegmental regions. Autologous transplantation of splenic pulp into the major omentum should be considered an alternative to splenectomy alone in strictly selected cases of massive splenic rupture.     

Surgical repair of a ruptured spleen in children: report of eight cases.

Ten consecutive children with clinical evidence of splenic rupture underwent surgical exploration. In eight patients, all or part of the spleen could be preserved. The two patients requiring splenectomy had associated injury to the tail of the pancreas. Surgical techniques employed to preserve the injured spleen were those in common use to repair equivalent hepatic or renal injuries. There was no morbidity or mortality associated with the procedure. Splenic salvage protects the child from increased susceptibility to sepsis associated with splenectomy.