复杂性脾脏切除及安全措施的探讨

目的:探讨复杂性脾脏切除的安全措施,总结复杂性脾脏切除的临床治疗经验。方法:对1998年1月—2013年11月收治的116例复杂性脾脏切除病例进行系统回顾,总结手术前影像学资料、术中各种病理解剖特点、术中特殊处理措施、术后并发症的处理以及临床治疗效果。结果:115例患者获得临床痊愈,1例死亡,死亡率0.86%。85例恢复顺利;30例患者术后出现并发症或合并症,发生率25.86%,主要为肺部感染、肺不张、腹水以及脾静脉血栓性静脉炎。结论:充分的术前检查和评估、规范的手术操作、脾周粘连的仔细分离及合理的脾蒂微出血离断措施,是确保复杂性脾切除安全的关键。

Safety measure investigation of complex splenectomy

Objective：To investigate the safety measures and to summarize the experiences of complex splenectomy.Methods：The 116 cases of complex splenectomy were analyzed retrospectively from January 1998 to November 2013,including the adjunctive imaging examinations the pathologic characteristics and the special managements during operation and the therapeutic efficacy.Results：The 115 cases were cured and 1 case was dead post complex splenectomy.The 85 cases were recovered smoothly and the 30 cases were occurred mild complication （accounting for 25.86％ among 116 cases）,including pulmonary infection,atelectasis,ascite and splenic phlebothrombosis.Conclusion：The careful evaluation before operation,standardized operative procedure,reasonable and effective dissection of perisplenic adhesion and the rational splenic peduncular cut with minute bleeding methods,which are the key managements to ensure the safety of complex splenectomy.