自体脾组织移植治疗脾破裂的临床应用

1982～1983年我院为12例外伤性脾破裂进行自体脾组织移植。平均年龄31岁(17～54岁);平均随访时间16个月。12例均采用全脾组织移植,其中1例移植前将脾用带孔擦板擦碎,7例用刀片切成2～3mm大小碎片,4例切成厚度不超过2mm的邮票状薄片。移植部位均采用大网膜。术后麻面红细胞和乔氏小体均明显升高,2～3周时达高峰,第8周时接近原来水平,半年后恢复正常、IgM在第5周开始轻度下降,第8周持续上升。同位素扫描11例中(8例为闪烁照像),10例显影。本文就脾组织移植量、脾块大小、移植部位和手术适应证进行了讨论。

Clinical Application of Autotransplantation of Traumatized Spleen

Between February 1982 and October 1983 autotransplantation of splenic tissue was performed here for 12 patients with traumatic rupture of spleen. Six patients were male, and six female, with an average age of 31 (17-54) years. The mean follow-up period was 16(8-28) months. To all of the patients the splenic tissue from the whole spleen was implanted. In one patient the spleen was grated into small particles by means of a grater. In seven patients it was cut into small pieces 2 -3mm in size. In four patients it was cut into stamp-like slices, less than 2mm thick. The great omen-tum was used as implantation site for all of our patients. Postoperatively, in all the patients pitted red cells, Howell -Jolly bodies, immunoglobulin (IgA,IgG, IgM) were examined regularly and radioisotope splenic scanning was performed. Pitted red cells and Howell-Jolly bodies increased significantly, reached their peak value 2-3 weeks after operation, then fell gradually. Eight weeks postoperatively they approximated the normal level and six months after operation, they were normal. The IgM levels began to decrease slightly at the fifth week after operation, from eighth week they rose steadily. Eleven patients were examined with radioisotope splenic scanning. Splenic function of the implants was demonstrated in ten. The amount and size of the implants, the sites of implantation and the indication for operation were discussed. As autotransplantation of splenic tissue is now still in clinical experimental stage,it should be used only when there is no other way to preserve splenic tissue. We suggest, when splenectomy alone can control the hemorrhage, autotransplantation of splenic tissue should be considered as simple and safe method to preserve splenic function.