脾破裂伤86例诊治探讨

目的探讨外伤性脾破裂伤急症诊断、治疗决策、手术方法。方法回顾性分析1998年1月。2007年12月抢救的脾破裂伤患者86例的临床资料。结果外伤性损伤81例（94．2％），其中急性78例，延迟性脾破裂3例，医源性损伤5例（5．8％）；闭合性伤71例（71／81，87．6％），开放伤10例（1213％）；合并其他脏器损伤31例（38．3％）；非手术治疗8例（9．3％），手术治疗78例（90．7％）。破裂级别：Ⅰ级10例，Ⅱ级46例，Ⅲ级19例，Ⅳ级11例。手术方式：脾切除术63例（80．8％），脾部分切除及修补术15例（19．2％）。手术后并发症12例。均获痊愈，无死亡。结论急性外伤性脾破裂患者抢救关键在于快速、准确判断伤情，及时选择合理的治疗方式，能获得较高的抢救成功率，也能争取保留脾脏功能。

Diagnosis and treatment of rupture of spleen: analysis of 86 cases

Objective To summarize the experience in emergent diagnosis and treatment strategy of traumatic rupture of spleen. Methods The clinical data of 86 patients with spleen rupture, 66 males and 20 females, aged 46 （16-65）, 55.8% being aged 30-50, admitted between Jan 1998 and Dec 2007 were analyzed retrospectively. Results There were 81 cases with traumatic rupture of spleen （94.2%）, including 78 cases with acute traumatic rupture and 3 with delayed rupture of spleen, whereas another 5 cases with spleen rupture caused by iatrogenic injuries （5.8%）. There were 71 cases with closed abdominal injury （87.6%） and 10 with open injury （12.3%）, 31 cases complicated with other organ injuries （38.3%）. Of all patients, 8 cases were given non-operative treatment （9.3%） and 78 eases given surgical operation treatment （90.7%）. Spleen-rupture scales： 10 cases for grade Ⅰ, 46 for grade Ⅱ, 19 for grade Ⅲ, and 11 for grade Ⅳ. Type of surgical operation for the patients： 63 cases with splenectomy （80.8%）, 15 cases with restorative operation and partial resection of the spleen （19.2%）. 12 patients had some complications after surgery and all recovered after treatment. Conclusion The success of emergent treatment for the patients with traumatic rupture of spleen depends on fast and accurate diagnosis and making quick and adequate decisions about treatment, so as to ensure a high success rate of emergent treatment and to enable the patients to preserve their spleen function.