脾损伤自体脾组织移植方法的对比研究

脾损伤自体脾组织移植方法的对比研究刘运奇林木生刘永源包仕庭柯小龙刘婷随着近年对脾脏功能认识的深入，学者们基本上达成共识：脾脏有独特的其它器官不代替的功能，不是体内可有可无的器官。因此，近年来采用非手术、脾修补、脾部分切除、脾动脉结扎等保脾措施治疗脾损...     

脾损伤自体脾组织移植的研究进展

脾移植可起一部分抗感染作用，目前对移植后脾组织的免疫功能尚有不同的看法，在未全面阐明的情况下，仍不应放弃脾组织移植术。移植部位以为宜，如脾损伤严重伴有腹腔污染时可行腹膜外移植。     

脾再生与脾自体移植

近20年来人们对脾组织自体移植进行了大量研究。作者复习了大量有关文献,并对外伤性脾切除脾自体移植后再生脾的作用给予中肯评价。     

自体脾组织片移植的临床观察

自体脾组织片移植的临床观察李益民崔宏何三光刘永锋我院从１９８１年１月至１９９６年１月共行外伤性脾切除后的自体脾组织片移植１４例，术后观察效果良好，现报告如下：脾破裂行自体脾组织片移植共１４例，男１１例，女３例。年龄６～５７岁，平均３３．５岁，其中脾组...     

自体脾片移植的研究现状

1919年Ｍｏｒｒｉｓ和Ｂｕｌｌｏｃｋ首先证明大鼠切除脾脏后抗感染功能减弱 ,脾脏具有抗感染功能。但直到 195 2年Ｋｉｎｇ报告了 5例患先天性家族型溶血性贫血 (遗传性球性红细胞症 ) 6个月以下的婴儿脾切除后 3年内继发严重感染 ,其中 2例死亡后 ,脾脏的功能才开始受到人们的重视。 196 9年这种现象被确定为“脾切除术后凶险性感染”(ＯＰＳＩ)。Ｓｉｎｇｅｒ〔1〕证实创伤性脾切除术后发生ＯＰＳＩ的概率为正常人群的 5 0倍 ,ＯＰＳＩ不仅发生于婴儿 ,成人也可发生 ,其危险性可伴随终生。 1986年Ｓｅｉｆｅｒｔ综合文献中成人切脾后因严…     

自体脾移植对免疫功能的影响

为探讨外伤性脾破裂行脾切除术(SE)与脾切除术加自体脾组织移植(AS)对免疫功能的影响。笔者观察了64例SE和42例AS的术后感染性疾病发生率与血清免疫物质水平的关系。结果显示： SE的感染率为78.13%， AS为61.90%，差别无显著性意义(P＞0.05)。SE的IgG和IgA高于AS(P＜0.05)，AS高于对照组(P＜0.05)，SE的IgM低于AS(P＞0.05)，显著低于对照组(P＜0.05)。C3的水平三者差别均无显著意义(P＞0.05)。提示：自体脾片移植能保留脾切除术后的部分免疫功能。     

自体移植脾组织的血流量及形态学的变化

对自体移植脾的组织量和血流量以及形态学进行动态观察，实验用大鼠分别于术后３、５、７、１２月通过生物微球法对和人动物保留１／４原位脾和地脾进行检测。结果得出，自体移植各时相点的单位重量血流量、血容积和吞噬指数与原位保留的相差不显著。原位保留的残脾重量代偿性增加，但移植脾组织量明显减轻，因而移植脾的绝对血流量也相应减少，揭示移植脾组织应尽量增多。镜检移植脾组织随着时间推移显示正常结构。     

脾损伤自体脾组织移植的研究进展(文献综述)

脾移植可起一部分抗感染作用,目前对移植后牌组织的免疫功能尚有不同的看法,在未全面阐明的情况下,仍不应放弃脾组织移植术.移植部位以腹腔内为宜,如脾损伤严重伴有腹腔污染时可行腹膜外移植.     

脾损伤自体脾组织移植的临床应用

目的：探讨自体脾组织移植在临床中的应用。方法：总结32例脾外伤行全脾切除自体脾组织移植手术，其中采用大网膜囊内移植18例，去粘膜游离空肠段内移植12例，腹直肌鞘内移植2例。结果：术后随访均显示脾功能满意，尤以去粘膜游离空肠段内移植效果最好。结论：自体脾组织移植可作为严重脾外伤、全脾切除术后保留脾功能的一个重要有效手段，移植脾的功能恢复与血供有密切的关系。     

Decreased phagocytic capacity of autotransplanted splenic tissue

Background: Asplenic patients have an increased risk of infections. Operations such as autotransplantation have been proposed to restore functional splenic tissue after splenectomy, but the protective value of this tissue is unclear. Immune responses such as production of antibody remain impaired in humans and animals even when such tissue is present, and clearance of particles from the blood is reported to be less efficient than by normal spleen tissue. The present study investigated the phagocytic capacity of cells in the regenerated tissue in vitro, free of the confounding effects of hepatic clearance. Methods: Single cell suspensions were prepared from splenic tissue from rats 6 months after splenic autotransplantation or sham operation. Phagocytosis of killed, fluorescein‐labelled bacteria was measured by flow cytometry. Results: Autotransplanted tissue contained fewer phagocytic cells than normal tissue, and these cells phagocytosed less per cell. Phagocytosis by spleen cells was dependent on heat‐labile opsonic factors. Conclusions: Autotransplanted splenic tissue does not restore the phagocytic capacity lost following splenectomy.     

Heterotopic splenic autotransplantation in prevention of overwhelming postsplenectomy infection.

An experimental study was undertaken to evaluate the protective effect of heterotopic splenic autotransplantation in weanling rats. Rats were divided into three experimental groups: splenectomy, control, and splenic autotransplantation. Rats were challenged with i.v. type I pneumococcus. Bacterial bloodstream clearance and survival were determined. Splenic bacterial uptake was measured by determining the isotopic activity of technetium-99m-labeled pneumococci. Autoradiographs and material stained with hematoxylin and eosin and Gram strains were examined for histologic features. All autografts survived and were histologically compatible with normal splenic tissue. Bloodstream clearance of pneumococci was significantly greater in rats with splenic autotransplantation. Splenic autografts had 10 to 30 times greater uptake of pneumocci than did the liver. Rats with autotransplantation had a prolonged survival time. Heterotopic splenic autotransplantation may prove to be an important adjunctive surgical measure in the treatment of children undergoing splenectomy.     

腹腔镜脾部分切除术治疗脾脏良性疾病体会

目的 总结腹腔镜脾部分切除术治疗脾脏良性疾病的经验和体会.方法 回顾性分析2014年1月至2020年12月在金华市中心医院14例行腹腔镜脾部分切除术的患者临床资料.结果 14例中脾脏上叶切除8例,脾脏下叶切除6例,均顺利完成腹腔镜手术,无中转开腹,其中2例在3D腹腔镜下完成.术后病理:脾囊肿6例,血管瘤4例,脉管瘤2例...     

Two-color flow cytometric analysis of splenic lymphocyte subpopulations in patients with gastric cancer

Lymphocyte subpopulations of the spleen were assayed in 26 patients with gastric cancer and 5 patients with benign disease using two-color flow cytometric analysis. The ratio of Leu 2a+·Leu 15+ cells, or suppressor T cells, in the gastric cancer patients was about 6 per cent, being higher than that in the patients with benign disease (p<0.05). There were fewer Leu 7+·Leu 11– cells, or natural killer-NK-cells, in the gastric cancer patients in stage III or IV than in those with stages I or II (p<0.05). The ratio of Leu 3a+·Leu 8– cells, or helper T cells, in the stage IV patients accounted for about 15 per cent of the splenic lymphocytes, which was less than that seen in the patients in stages I or II (p<0.05). The ratio of Leu 2a+·Leu 15– cells, or cytotoxic T cells, was approximately twice that of suppressor T cells. The pre-operative administration of lentinan plus OK-432 increased the ratio of Leu 4+·HLA-DR+ cells, or activated T cells, and cytotoxic T cells (p<0.05 and p<0.01, respectively). The above results suggest that lymphocyte subpopulations in the spleen may have more immuno-suppressive potential in proportion with the stage of gastric cancer, but that this reduced immune state may be altered when lentinan and OK-432 are given to these patients.     

腹膜后自体脾移植治疗外伤性脾破裂的前瞻性研究

目的 探讨腹膜后自体脾移植在严重脾外伤保脾手术中应用的可行性及价值。方法 采用前瞻性病例对照研究,将66例严重脾外伤病人分为腹膜后自体脾移植组例、大网膜自体脾移植组,其中腹膜后自体脾移植组32例,大网膜自体脾移植组34例。观察术后一般情况,术后1天～ 12个月血常规,血IgA、IgM、IgG、C3、Tuftsin水平变化。结果 腹膜后自体脾移植组手术时间短于大网膜自体脾移植组（P<0.05）,术后其它一般情况变化、术后1天～ 12个月血IgA、IgM、IgG、C3、Tuftsin水平两组无统计学差异（P> 0.05）。结论 腹膜后自体带蒂脾移植术能够保留脾脏的部分免疫功能,且手术操作简便,在临床上推广应用是可行的。     

脾脏肿瘤29例诊治分析

目的探讨脾脏肿瘤的临床诊断与治疗对策。方法所有病例均行B超检查,18例并行CT检查,3例并行多普勒彩超检查,另有2例行MRI检查。全部病例均行脾脏切除术治疗,其中6例合并胰体尾切除。结果29例病例中良性肿瘤19例;恶性肿瘤10例,包括3例转移性脾肿瘤。B超与CT的阳性检出率分别为93.1%与94.4%;彩超与MRI全部检出异常。术后恢复均较顺利,无手术死亡病例及术后并发症。结论影像学检查是脾脏肿瘤诊断的主要手段,结合其他检查方法有助于定性诊断准确率的提高;手术治疗仍是多数脾脏肿瘤的主要治疗手段,但非唯一选择。     

Distal pancreatectomy with preservation of the spleen and splenic vessels

This article draws attention to the concept of distal pancreatectomy with splenic preservation including the splenic artery and vein.     

52例非梗阻性结肠脾曲癌脾曲解剖学特点及外科治疗

目的探讨52例非梗阻性结肠脾曲癌患者的脾曲解剖特点、手术要点及疗效。方法回顾性分析河南省肿瘤医院普通外科2004年3月至2011年3月间收治的52例非梗阻性结肠脾曲癌患者的临床资料。结果根据术中所见,52例患者结肠脾曲为系膜型者37例,游离型者5例,粘连型者10例。所有患者均行根治性手术,18例患者行原位结肠吻合,其中系膜型者12例（32．4％）,游离型者4例（4／5）,粘连型者2例（20．0％）,粘连型比例低于系膜型,但差异并未达到统计学意义（P=0．062）：另32例患者行回肠后结肠吻合。3种脾曲解剖类型患者手术时间、术中出血量、淋巴结清扫总数、阳性淋巴结数量、术后并发症的差异均无统计学意义（均P〉O．05）。52例患者术后均获随访,系膜型者、游离型和粘连型患者术后5年生存率分别为62．5％、59．2％和58．7％,差异无统计学意义（P〉O．05）。结论解剖学类型并不影响脾曲癌根治术中结肠吻合的方式,但经回肠后方吻合可有效保障结肠脾曲癌的切除范围．有助于提高手术根治性．