目的 探讨非手术治疗外伤性脾破裂的可行性及适应证。 方法 回顾分析1998年以来山东省聊城市第二人民医院非手术治疗88例外伤性脾破裂的临床资料及其治疗效果。结果 88例均经B超检查确诊脾破裂，Ⅰ级损伤19例，Ⅱ级损伤57例，Ⅲ级损伤12例，其中16例患者合并肋骨骨折，11例合并肝外伤，9例合并肾挫伤，4例合并颅脑损伤，3例中转手术。结论 有选择地采用非手术治疗外伤性脾破裂安全、有效，轻度的肝肾损伤、腹腔外器官合并伤及患者的年龄并不影响非手术治疗的疗效。
From 1982 to 1991, there were 13 cases of traumatic rupture of spleen, 26 percent in a total of 50 cases of splenic rupturesin the same period. The abdominal punctures were all positive preoperatively. In general, traumatic rupture of spleen should bc first repaired, if it failed, the subsplenectomy or transplatation of autosplenic tissues in the omental sack might be adopted. We used the technique to repair the ruptured splenic tissues in order to achieve cure. They did not require a second operation. Immunoiogical evaluation was normal 3-4 week safter operation .No postoperative sepsis was encountered.The follow-up results were good (1-7years,mean 3.5years).
ObjectiveTo summarize the treatment effects and success rate of spleen-preserving treatments for patients with splenic injury, and to explore the ideal spleen-preserving treatment for different types of splenic injury. MethodWe retrospectively analyzed the clinical data of 136 patients with splenic injury who underwent spleen-preserving treatment in the Department of Hepatobiliary Surgery between July 1998 and December 2010. And the treatment effects of different combined treatment methods were compared and studied. ResultsTwenty-seven patients were treated without surgery; 23 underwent vascular suture combined with fibrin glue treatment; 26 accepted splenic artery ligation, partial suture and fibrin glue treatment; 20 underwent ultrasonic scalpel partial splenectomy and wound spray fibrin glue treatment; 17 accepted splenic artery ligation and RF hemostatic cutter row spleen resection; and 23 accepted laparoscopic ultrasonic scalpel with partial splenectomy and wound spray fibrin glue treatment. Spleen-preserving succeeded in 131 cases (95.58%) and failed in 5 cases (4.42%) without any deaths. ConclusionsIn the treatment of splenic injury, the success rate of different methods of spleen-preserving is close. The success rate of combined use of several spleen-preserving methods together is higher. Under the principle of "Save lives first, and preserve spleen second", we should carry out individualized treatment plan for the patients based on patients' general condition, the extent and grade of splenic rupture, and medical equipment and technical conditions. For those medical units with good treatment conditions, combined spleen-preserving treatment can be performed.
In order to preserve more normal tissue in situ in case of severe traumatic rupture of spleen, simultaneous ligation of splenic artery and vein was performed successfully on animals and then was applied for clinic use. The preserved splenic tissue all survivied and functioned well. Patients with severe traumatic rupture of spleen grade Ⅳ-Ⅴ were all cured by ligation of both the splenic artery and vein at the same time.
目的 探讨脾切除术后再出血的原因及诊治方法并总结其预防措施。方法 对我院1998年8月至2009年3月收治的11例脾切除术后再出血患者的临床资料进行回顾性分析。结果 本组11例再出血患者均行急诊再手术治疗，10例治愈,无术后并发症，恢复顺利，切口愈合良好，均拆线出院，术后住院10～21 d（平均15 d）； 余1例外伤性脾破裂者术中探查为胃短动脉破裂出血，遂结扎胃短动脉，术后发生胃瘘，经禁食、静脉营养等治疗，效果差，于术后20 d死亡。结论 脾切除术后再出血原因较多，以胃短血管处理不当、脾蒂血管结扎线脱落、胰尾部血管损伤及患者凝血功能障碍为主。脾切除术后出血以预防为主，术前充分做好各项准备，术中止血彻底，术后特别是术后24 h内严密观察腹腔引流液的量、性质及速度。再出血后果严重，一旦发生，应及时准确诊断，行急诊再手术治疗。
ObjectiveTo analyze the platelet (PLT) count, coagulation function, and portal vein thrombosis (PVT) in the patients underwent splenectomy due to different etiologies. MethodsThe patients who underwent splenectomy in the Affiliated Hospital of Southwest Medical University from January 2013 to December 2022 were collected. According to the etiology, the patients were assigned into the occupying group (splenic and pancreatic occupying lesions), hypersplenism group (portal hypertension and hypersplenism), and splenic rupture group (traumatic splenic rupture). The changes of PLT, white blood cells (WBC), red blood cells (RBC), neutrophils (Neut), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib), D-dimer (DD), and PVT were observed after splenectomy. ResultsA total of 166 patients were collected, including 42 in the occupying group, 22 in the hypersplenism group, and 102 in the splenic rupture group. There were no statistically significant differences in the age and preoperative Child-Pugh score among the patients of the three groups (P>0.05). There were 12 (7.2%) patients with PVT, including 2 in the occupying group, 6 in the hypersplenismn group, and 4 in the splenic rupture group. The PVT incidence among the three groups had a statistical significant difference (Fisher exact test, P=0.003), which in the hypersplenismn group was higher than the occupying group (P=0.016) and the splenic rupture group (P=0.002), while there was no statistically significant difference between the occupying group and the splenic rupture group (P=1.000). The overall trend was that the PLT, RBC, WBC, and various coagulation function indicators such as PT, APTT, and Fib among the three groups all showed an upward trend immediately after splenectomy, but the postoperative peak time and change trends had no markedly regular among the three groups. The PLT of the patients with and without PVT changed over time during the observation period (patients without PVT: F=60.238, P<0.001; patients with PVT group: F=9.700, P=0.043), and which showed a continuous upward trend after surgery, reaching a peak on the 14th day and then beginning to decline in the patients of both 2 groups. However, there was no statistically significant intergroup effect between the 2 groups (F=0.056, P=0.816). ConclusionsThe results of this study suggest that the peak value of PLT in the hypersplenism group is lower as compared with the occupying group and the splenic rupture group, and the PVT is more likely to occur. However, no difference of the PLT level is found in the patients without and with PVT.
ObjectiveTo investigate the safety and feasibility of the treatment of laparoscopic splenectomy for patients with traumatic splenic rupture. MethodsBetween October 2006 and October 2009, 48 cases of traumatic splenic rupture underwent laparoscopic splenectomy were analyzed in this hospital. According to the differrent styles of splenic stalk, different operative methods were taken， including titanic clipping in 12 cases， titanic clipping combining silk suture ligation in 8 cases， snare combining titanic clipping in 10 cases， LigaSure in 8 cases， and EndoGIA in 8 cases. ResultsLaparoscopic splenectomy was successfully completed in 32 cases; Handassisted laparoscopic splenectomy was applied in 14 cases, and 2 cases were converted to laparotomy because of tight spleen adhesion with surrounding tissues and bleeding rupture of the short gastric vessels. The operation time was 120－170 min with an average 140 min; the estimated intraoperative amount of blood loss was 300－1 200 ml with an average 800 ml. No postoperative complication occurred such as gastric fistula, pancreatic fistula or hemorrhage. Conclusion According to the differrent styles of splenic stalk, individual operative method can improve mission success rate in the laparoscopic splenectomy in traumatic splenic rupture.
Objective To compare the difference of the changes of platelet counts after splenectomy between the patients with splenic rupture and patients with cirrhosis and portal hypertension, and to analyze the possible reasons and clinical significance. Methods The platelet count of 47 splenic rupture patients and 36 cirrhosis patients who had been carried out splenectomy from July 2008 to December 2009 in our hospital were counted, and the differences in platelet count and it’s change tendency of two groups were compared. Results In the splenic rupture group，the platelet count of all 47 patients increased abnormally after operation, the maxlmum value of platelet count among 300×109/L-600×109/L in 6 cases，600×109/L-900×109/L in 21 cases，and above 900×109/L in 20 cases. In the cirrhosis group，the maxlmum value of platelet count after operation was above 300×109/L in 26 cases，100×109/L-300×109/L in 8 cases，and below 100×109/L in 2 cases. The difference of maxlmum value of platelet count in the two groups had statistic significance（P=0.00）. Compared with the cirrhosis group, the platelet count increased more significant and decreased more slow in splenic rupture group（P＜0.05）.The abnormal days and rising range of platelet count were higher in patient with Child A than Child B and C（P=0.006，P=0.002）. Conclusions The change of platelet count after operation in splenic rupture group was obviously different from cirrhosis group because of the difference of the liver function and body situation of patients. To patients with splenic rupture or cirrhosis, appropriate treatment based on the platelet count and liver function could obtain good therapeutic effect.