外伤性脾破裂保脾治疗46例

目的探讨外伤性脾破裂保脾方法的选择。方法回顾性分析1995年至2003年间保脾治疗的46例患者的诊断与治疗方法。结果46例患者分为非手术治疗组、脾修补组、脾切除加自体移植组和血管介入脾动脉栓塞组4组。非手术治疗23例(脾损伤Ⅰ级8例,Ⅱ级10例,Ⅲ级1例,4例不详),其中3例伴休克。非手术治疗占同期脾外伤20%(23/115)。脾修补治疗9例(Ⅱ级1例,Ⅲ级7例,Ⅳ级1例),7例伴休克。全脾切除加脾组织大网膜移植术8例(Ⅲ级1例,Ⅳ级7例),其中5例伴休克。介入组6例(Ⅱ级2例,Ⅲ级4例),无休克,均一次脾动脉栓塞成功。46例均无并发症发生。痊愈45例,1例因合并颅脑损伤呈植物状态。4组患者住院时间均无差异。结论脾脏Ⅰ、Ⅱ级损伤以非手术治疗为主,Ⅲ级损伤以脾动脉栓塞或手术修补保脾为主,Ⅳ级以上的损伤只能手术保脾,同时结合实际情况进行个体化综合治疗。

The Preserving Therapy of Traumatogenic Spleen Rupture in 46 Cases

Objective To investigate the therapeutic methods of preserving spleens for splenic injuries.Methods The diagnosis and treatment of 46 patients with splenic trauma from 1995 to 2003 were reviewed retrospectively.Results All patients were divided into four groups, nonoperative group, operative repairing group, spleen resection plus autotransplantation group and vascular intervention group(splenic artery embolism).Twenty-three patients in the nonoperative group according to trauma grade were classified as grade Ⅰ in 8 cases, grade Ⅱ in 10 patients, grade Ⅲ in 1 patient and unknown grade in the rest 4 cases respectively.Three cases had traumatic shock.Nonoperative therpy accounts for 20% in the treatment of all splenic trauma.In the repairing group, nine cases were classified as grade Ⅱ in 1 case, grade Ⅲ in 7 cases and grade Ⅳ in 1 case, and 7 cases had shock in the group.Total spleen excision and autotransplantation were performed for 8 cases with grade Ⅲ in 1 case and grade Ⅳ in₇ cases, and 5 patients had shock.Six patients classified as grade Ⅱ and Ⅲ included 2 cases and 4 cases respectively in the splenic artery embolize group, and all patients without shock were treated successfully with one time embolization.All 46 patients had no complications, and 45 cases were recovered except one being in vegetative status caused by craniocerebral injury.There were no significant difference in hospitalization in the four groups.Conclusion Splenic injuries of grade Ⅰ and Ⅱ may be given priority to nonoperative therapy, and grade Ⅲ is fit for splenic artery embolism or repairing for preserving spleen.Splenic trauma of grade Ⅳ or above should only be operated for preserving spleen.And therapeutic methods should be selected according to individual's condition and combined agilely.