脾损伤的脾保留手术——10年经验总结

目的：本文旨在阐明脾损伤的外科处理原则，结合我们10年来保脾手术的经验探讨脾保留手术的适应证、手术技术及疗效。方法：回顾性分析1989年5月至1999年5月间收治的166例脾损伤行保留性脾手术病例。结果：本组病例无死亡，保脾成功108例（65．1％）。58例（34．9％）被迫行脾切除，40例（56％）同时行脾组织自体移植。所有脾保留性手术均无并发症发生。109例术后平均随访13．5个月，脾功能良好，无感染并发症。结论：保留性脾手术在选择适当的病例中可安全施行。成功实施取决于三因素：格守脾损伤处理的一般原则，依脾损伤类型及病人状况选择恰当术式，掌握保脾术式的技术要点。

Technique of splenic salvage procedure for splenic injury: clinical experience of 10 years

Objective To clarify the general principle for management of splenic injury and discuss the indications and technique of commonly used splenic salvage procedures based upon our 10 year experience and views on it in recent years. Methods A total of 166 cases of splenic injury treated by different splenic preservation methods from May 1980 to May 1999 in our hospital were retrospectively studied. Results There was no postoperative death in this group of patients and the spleen was preserved in 108 patients (65 1%). Splenectomy was inevitable in 58 patients (34 9%) and splenic tissue autotransplantation was added as an alternative approach in 40 (56%). No complications due to any of these spleen saving procedures were found. Splenic function was well maintained in 109 patients who were followed up for an average of 13 5 months. Meanwhile, sepsis was not found in these 109 patients. Conclusions The technique of splenic salvage can be safely performed in properly selected patients. The main factors determining success of conservative splenic surgery are: adhering to general principle for treatment of splenic injury, choosing proper operative procedure according to the classification of the injury and the condition of patients as well as grasping the technical points of each approach.