经粒细胞集落刺激因子动员的正常供者自发性脾破裂一例——附文献复习

目的讨论异基因外周血造血干细胞移植过程中粒细胞集落刺激因子（G—CSF）的不良反应及其动员的正常供者的安全问题。方法报道国内第1例经G—CSF动员的正常供者自发性脾破裂，并进行相关文献复习。结果本文供者和3例文献报道的供者，在G—CSF动员后脾脏均增大并发生自发性脾破裂；1例文献报道的供者，在G—CSF动员后脾脏未增大，但也出现自发性脾破裂。结论供者在G—CSF动员、采集过程中、采集后出现腹痛、头昏时应警惕脾破裂的发生。     

创伤性脾破裂的临床特点及外科治疗

目的分析创伤性脾破裂的临床特点,总结创伤性脾破裂的诊治经验,以提高诊治水平。方法通过随访,回顾性分析1984-2004年间265例脾破裂的临床治疗资料。我们将脾破裂的B超影像分为四个类型:(1)脾包膜下破裂;(2)脾中央性破裂;(3)脾真性破裂;(4)脾蒂撕裂。结果本组B超诊断符合率为98.6%;行脾切除术194例,脾修补术18例,脾动脉结扎10例,脾部分切除4例;死亡5例,为严重多发伤或脑疝患者。非手术治疗39例,全部治愈。结论在创伤性脾破裂的治疗中,要遵循“抢救生命第一,保留脾脏第二”的原则,脾切除术具有肯定的疗效而且并发症发生率和死亡率低。B超应作为创伤性脾破裂及其随访观察的首选检查指标。     

外伤性脾破裂非手术治疗的探讨

目的探讨外伤性脾破裂非手术治疗的可行性、适应证及其治疗效果。方法回顾性分析2000年4月至2009年9月间我院收治的68例外伤性脾破裂非手术治疗的临床资料及其治疗结果。结果所有病例均经B超及CT检查明确诊断为脾破裂。非手术治愈63例。中转手术5例,其中2例分别在治疗的第3天和第5天发生迟发性出血．2例因提前下床活动导致大出血,1例在第5天血肿继续增大,考虑非手术治疗失败而中转行脾切除术,其中1例并发左膈下感染,经保守治疗痊愈。无死亡病例。治疗成功率92．6％,平均住院18d。结论选择性的在严密监测下非手术治疗对外伤性脾破裂是安全可行的,腹外器官合并伤以及患者的年龄并不影响非手术治疗的成功。     

非手术治疗创伤性脾破裂体会

目的：探讨非手术治疗创伤性脾破裂的可行性。方法：对非手术治疗创伤性脾破裂病例进行回顾性分析。结果：选择非手术治疗的46例创伤性脾破裂患者，均获得治愈。结论：只要严格掌握适应症，密切观察病情，正确治疗，非手术治疗创伤性脾破裂是一种安全有效的疗法。     

非手术治疗脾破裂的临床分析

目的:探讨非手术治疗脾破裂的选择标准和监测指标。方法:回顾性分析本院2001年10月至2005年9月非手术治疗脾破裂42例病人的临床资料。结果:37例病人痊愈出院,无任何后遗症;5例病人因继续出血或延迟出血或并发症而转为手术治疗。结论:严格选择非手术治疗脾破裂标准,严密监测指标,合理治疗有效。     

血吸虫病并发急性脾破裂118例诊治体会

目的：总结血吸虫病并发急性脾破裂的临床诊断与治疗。方法：回顾我院1996年8月2007年8月的血吸虫痫斤发胛破裂118例患者的诊断治疗的临床资料。结果：非手术治愈6例．手术治愈112例。其中脾切除术106例,脾修补3例．脾切除脾片大网膜移植术3例,无死亡病例。结论：对血吸虫病并发脾破裂要及时诊断．选择适当的治疗方法,遵循抢救生命第一,保留脾脏第二的原则,病理性脾脏须行脾切除手术。     

外伤性脾破裂非手术治疗的观察与护理（附37例报告）

总结37例外伤性脾破裂非手术治疗患者的观察和护理。正确掌握外伤性脾破裂的非手术治疗适应证以及实施科学、合理、有效、及时、个体化的治疗和护理措施是保证患者生命安全,促进患者顺利康复的重要保障。     

外伤性脾破裂保守治疗的护理

目的：探讨外伤性脾破裂保守治疗的病情观察及护理方法并加以总结分析。方法：对2010年9月～2011年9月行保守治疗的10例脾破裂患者护理方法进行回顾性分析。结果：保守治疗10例,成功9例,1例保守治疗3 d后行手术治疗。结论：通过细心的生命体征观察,正确的护理方法降低患者腹内压以及耐心的心理护理,对外伤性脾破裂保守治疗有切实的帮助。     

创伤性脾破裂非手术治疗26例

目的探讨创伤性脾破裂非手术治疗的方法及适应证。方法回顾性分析26例创伤性脾破裂患者进行非手术治疗的临床资料。结果 26例患者中有3例因腹腔内出血量增加,行脾切除术。其余23例患者非手术治疗后痊愈出院。住院时间14~35 d,平均28 d。无死亡病例。结论严格选择非手术治疗的适应证是治疗成功的关键。     

Splenic Rupture Manifesting Two Years after Diagnosis of Injury

The entity of delayed splenic rupture is often challenged. This case report describes a patient who presented with splenic rupture 2 years after a prior splenic injury from blunt trauma. The pathology report confirmed previous splenic injury. Delayed splenic rupture is possible for extended periods following splenic injury managed conservatively.     

Post-traumatic intrasplenic pseudoaneurysms with delayed rupture: color Doppler sonographic and CT findings.

Post-traumatic intrasplenic pseudoaneurysms are very rare in children. Since pseudoaneurysms may expand a splenic hematoma and cause delayed splenic rupture, early diagnosis and treatment are crucial. In this report, we describe the case of a 12-year-old boy with a delayed splenic rupture caused by a splenic hematoma containing 2 pseudoaneurysms. Abdominal sonography showed free intraperitoneal fluid and a mildly enlarged spleen with a large heterogeneous area occupying the upper half of the organ. Two anechoic lesions (15 and 4 mm) were seen inside the hematoma near the splenic hilum. Color Doppler sonography demonstrated turbulent arterial flow within the lesions, suggesting pseudoaneurysms. On CT, the lesions enhanced simultaneously with the splenic artery in the arterial phase of contrast enhancement. CT also showed an intrasplenic arterial branch leading to the larger of the 2 pseudoaneurysms.     

外伤性脾破裂96例临床分析

目的探讨外伤性脾破裂的诊断与治疗经验,提高救治水平。方法回顾性分析九龙坡区第一人民医院1996年1月至2008年12月收治的96例外伤性脾破裂患者的临床资料。结果非手术治疗11例全部治愈;手术组80例,治愈78例,死亡2例;术后未发生脾切除后凶险感染等严重并发症。结论外伤性脾破裂的治疗应根据患者个体情况及脾破裂的类型而定。手术仍是治疗脾损伤的主要方法 ,非手术治疗应严格掌握适应证。     

Splenic lymphoma with massive splenomegaly: Case report with review of literature

As per strict criteria of Das Gupta et al, primary splenic lymphoma is very rare. Herein, we are reporting an unusual case of primary large cell splenic lymphoma of B lineage in a middle aged female presenting with massive splenomegaly (3.8 kg) and hypersplenism. After performing therapeutic splenectomy for hypersplenism, a precise diagnosis of diffuse large B cell lymphoma was made on histopathology and confirmed by immunohistochemistry. The patient responded well to standard (Cyclophosphamide, Hydroxydaunorubicin, Oncovin (vincristine), Prednisone or prednisolone) regimen last year and is now in full remission. The splenectomy thereby has prevented the potential grave complications related to hypersplenism and splenic rupture. Our aim behind highlighting the topic is to specify that emergency splenectomy followed by anticoagulation therapy is an effective plan of management to prevent untoward complications related to disease and treatment.     

Splenic rupture and infectious mononucleosis

Infectious mononucleosis is an acute viral illness associated with a high incidence of splenomegaly, although the incidence of splenic rupture is low. When rupture occurs, the mortality has been significant, presumably, because a history of trauma is not present. The spleen may be vulnerable to injury due to the histopathologic changes that occur as a result of this illness. Essentially all patients with spontaneous rupture related to infectious mononucleosis have epigastric or upper abdominal pain. The diagnosis of splenic rupture may be confirmed in a variety of ways. In those patients who are hemodynamically stable, CT scan, ultrasound, or radionuclide scan may aid in establishing the diagnosis. Selective splenic angiography is very accurate but has been largely abandoned because of the invasive nature of the study. Peritoneal lavage is efficacious in establishing the diagnosis in hemodynamically unstable patients. The treatment of choice, at this time, is splenectomy. Current interest in splenic salvage has resulted in reports of nonoperative therapy in stable patients and splenorrhaphy in one instance. Due to the extent of the histologic changes in the spleen, caution is urged in electing the conservative approach to this clinical situation.     

创伤性脾破裂非手术治疗体会

目的探讨闭合性腹部外伤致脾破裂非手术治疗的可行性。方法对1996年10月~2006年10月收治的25例外伤性脾破裂患者的临床资料进行回顾性分析。结果非手术治疗25例,成功23例,成功率(92.0%)。结论选择合适的脾破裂患者行非手术治疗是安全、有效的。     

外伤性脾破裂80例诊治分析

目的：探讨外伤性脾破裂的诊断和外科治疗原则。方法：回顾分析2004年1月—2010年1月收治的80例外伤性脾破裂患者的临床资料进行。结果：结合病史、腹腔穿刺、腹部B超或CT检查结果,所有患者均获得及时诊断。手术治疗74例,其中脾切除42例（52.5%）,保脾手术32例（40%）,非手术治疗6例（7.5%）。所有病例均治愈。结论：及时诊断是治疗的前提,脾切除术是首选的手术,选择合适的患者行保脾手术或者非手术治疗是安全、有效的。     

106例外伤性腹腔脏器破裂患者的救治

９年间救治成功的１０６例外伤性腹腔脏器破裂患者（其中肝破裂１９例，脾破裂４６例，胃破裂１０例，十二脂肠破裂３例，空肠、回肠破裂１９例，结肠破裂７例，胰腺破裂７例；复合创伤者４５例，特重症１８例）的救治成功经验：迅速组织强有力的抢救组进行抢救；加强治疗和护理，立即开放两条以上静脉通道积极扩容，从速作好术前准备；抗休克的同时行紧急剖腹探查、剖腹止血及修补破裂的脏器是治疗本病的关键性措施；特重症病例配合“四大一支持”等独特、快速、果断、正确、合理的治疗和ＩＣＵ监测是救治成功的关键     

Hydroxyurea and splenic irradiation-induced tumour lysis syndrome: a case report and review of the literature

Therapeutic agents for chronic myeloid leukaemia (CML) in the chronic phase include hydroxyurea, interferon alpha, allogeneic stem cell transplantation and the tyrosine kinase inhibitor imatinib (STI 571, Gleevec). For elderly patients, oral hydroxyurea is suitable for the relief of symptoms caused by hyperleukocytosis, and splenic irradiation would be considered if abdominal discomfort or fullness induced by splenomegaly were present. Tumour lysis syndrome (TLS) is seldom seen in the treatment for CML, and TLS caused by hydroxyurea or splenic irradiation is rarely observed. Herein, we report an elderly CML patient who received treatment with hydroxyurea, allopurinol, hydration and splenic irradiation. After 3 days, acute TLS developed. Aggressive supportive treatment, including haemodialysis, stabilized the condition.     

Spontaneous nontraumatic intrasplenic pseudoaneurysm: causes,sonographic diagnosis,and prognosis

PURPOSE: The aim of this study was to describe the incidence, causes, sonographic features, therapy, and prognosis of nontraumatic intrasplenic pseudoaneurysms (NTISPs), a rare complication of splenic infarction or infiltration by malignant systemic disorders or infectious diseases. METHODS: We retrospectively reviewed the medical and sonographic records of all patients seen at our clinic from July 1985 through December 2000 to identify patients with a sonographic diagnosis of spontaneous nontraumatic splenic rupture. We then examined the features of the resulting cases to identify patients in whom NTISPs were revealed by color Doppler sonography. RESULTS: In total, 41 patients were identified. Among those patients, 5 (12%) had NTISPs. Three of those 5 patients had an underlying malignant disorder (1 case of non-Hodgkin's lymphoma and 2 cases of chronic myelogenous leukemia), and the other 2 had an inflammatory disease (1 case of endocarditis and 1 case of pancreatitis). Three of the patients also had splenic infarctions. Three patients underwent splenectomy; in 2 of them, secondary delayed splenic rupture occurred before or during splenectomy. In 2 other patients, spontaneous thrombosis of the aneurysms occurred (after 16 hours in 1 and 15 days in the other). CONCLUSIONS: NTISPs may occur in about 12% of patients with sonographically detected nontraumatic spontaneous splenic rupture. NTISPs appear to be associated with an increased risk of secondary delayed splenic rupture, although spontaneous thrombosis may occur. Short-term follow-up sonographic examinations, particularly with color Doppler imaging, are recommended for early recognition of progression of NTISPs, which can guide treatment decisions.     

Ceroid histiocytosis: an unusual cause of atraumatic splenic rupture

A rare case of atraumatic splenic rupture due to ceroid histiocytosis is described in a 56-year-old man. During hospitalization, he complained of epigastric pain, which was not associated with nausea or vomiting. Hematologic indices showed steadily declining hemoglobin, and subsequent radiologic imaging revealed massive splenomegaly. An exploratory laparotomy revealed hemoperitoneum associated with a subcapsular splenic rupture. Splenic pathology showed numerous ceroid-containing histiocytes. We believe this to be the fourth reported case in the English language of atraumatic splenic rupture due to ceroid histiocytosis.