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OPERATION OF RETAINING SPLEEN FOR SPLEEN TRAUMA (REPORT OF 77 CASES)

目的 探讨外伤性脾破裂手术适应证和方法。方法 对77例外伤性脾破裂进行保脾手术治疗，按姜洪池脾损伤四级分类法： Ⅰ级8例，Ⅱ级41例，Ⅲ级18例，Ⅳ级10例。附加脾动脉结扎术6例。结果 死亡4例； 2例并粘连性肠梗阻。获随访45例，随访时间3个月至3年，仅4例儿童有反复上呼吸道感染，无1例发生脾切除后凶险感染(OPSI)。结论 根据脾损伤的部位和程度，可采用两种以上的联合保脾术式，对控制伤脾出血及保留脾脏功能有重要价值。

脾脏原发性恶性肿瘤（附8例报告）

腹腔镜保留脾脏胰体尾切除术(附7例报道)

目的探讨经腹腔镜下保留脾脏胰体尾切除术（LSPDP）在治疗胰腺体尾部良性肿瘤的可行性及手术技巧。 方法对我院2009年6月至2013年12月期间行LSPDP治疗7例胰腺体尾部良性肿瘤患者的临床资料进行回顾性分析。 结果7例均无中转开腹，平均手术时间218.57 min（120～300 min），术中平均出血量135.71 mL（50～300 mL），术后平均住院时间12.14 d（7～21 d）。术后2例B级胰瘘，经充分引流后出院；1例脾下极局灶性梗死，经保守治疗后治愈。术后病理诊断：胰腺浆液性囊腺瘤4例，胰腺神经内分泌肿瘤3例。术后随访12～48个月，均未出现脾梗死和食管胃底静脉曲张、出血。 结论对胰腺体尾部良性肿瘤患者行LSPDP具有恢复快、并发症少等优点。

射频消融在脾脏外伤后保脾手术中的临床应用

目的 探讨射频消融在保脾手术治疗脾脏外伤中的临床应用效果。 方法 回顾性分析笔者所在医院科室于 2010 年 7 月至 2015 年 3 月期间行保脾手术治疗的 23 例脾脏外伤患者的临床资料，术中均利用了射频消融技术。 结果 23 例患者均保脾成功，其中 11 例行射频消融止血修补术，12 例行射频消融联合部分脾脏切除术。手术时间为 75～150 min，平均 117 min；术中出血量为 40～500 mL，平均 223 mL；术中见腹腔出血量 800～2 000 mL，平均 1 452 mL，均行自体血回输；术中见脾脏裂伤程度：Ⅰ 度 10 例，Ⅱ 度 11 例，Ⅲ 度 2 例；拔除引流管时间为术后 2～5 d，平均 2.8 d；术后住院时间为 6～15 d，平均 8.5 d。术后出现发热 3 例，腹腔再次出血 1 例，血小板计数升高 7 例。术后获访 16 例，随访时间 8～26 个月，中位数为 11 个月。随访期间患者健康情况良好，未见血小板计数异常、脾脓肿等情况。 结论 射频消融在保脾手术治疗脾脏外伤中的应用是可行的。

Risk factors for intraoperative massive hemorrhage in patients with pancreatitis-induced sinistral portal hypertension

ObjectiveTo analyze risk factors of intraoperative massive hemorrhage in patients with pancreatitis-induced sinistral portal hypertension (SPH) and to explore its strategies of treatment.MethodsThe clinical data of patients with pancreatitis-induced SPH admitted to the West China Hospital of Sichuan University from January 2015 to March 2018 were retrospectively analyzed. The intraoperative massive hemorrhage was defined as the blood loss exceeding 30% blood volume. The factors closely associated with the intraoperative massive hemorrhage were analyzed by the forward logistic regression model.ResultsA total of 128 patients with pancreatitis-induced SPH were enrolled in this study, including 104 males and 24 females, with an average age of 47 years old and a median intraoperative bleeding volume of 482 mL. Among them, 93 patients with pancreatitis-induced SPH caused by the pancreatic pseudocyst after acute pancreatitis and 35 caused by the chronic pancreatitis. There were 36 patients with history of upper gastrointestinal bleeding and 46 patients with hypersplenism. Thirty-six patients suffered from the massive hemorrhage. Among them, 30 patients underwent the distal pancreatectomy concomitant with splenectomy, 1 patient underwent the duodenum- preserving resection of pancreatic head, and 5 patients underwent the pseudocyst drainage. The univariate analysis showed that the occurrence of intraoperative massive hemorrhage in the patients with pancreatitis-induced SPH was not associated with the gender, age, body mass index, albumin level, upper gastrointestinal bleeding, hypersplenism, type of pancreatitis, course of pancreatitis, number of attacks of pancreatitis, size of spleen, maximum diameter of lesions in the splenic vein obstruction site, or number of operation (P>0.05), which was associated with the diameter of varicose vein more than 5.0 mm (χ2=19.83, P<0.01), the intraperitoneal varices regions (χ2=13.67, P<0.01), the location of splenic vein obstruction (χ2=5.17, P=0.03), the operation time (t=–3.10, P<0.01), or the splenectomy (χ2=17.46, P<0.01). Further the logistic regression analysis showed that the varicose vein diameter more than 5.0 mm (OR=6.356, P=0.002) and splenectomy (OR=4.297, P=0.005) were the independent risk factors for the intraoperative massive hemorrhage in the patients with pancreatitis-induced SPH.ConclusionsSplenectomy and having a collateral vein more than 5.0 mm in diameter are independent risk factors for intraoperative massive blood loss in surgeries taken on patients with pancreatitis-induced SPH. Attention should be paid to dilation of gastric varices and choice of splenectomy.

Indications and Techniques of Spleen-Preserving Distal Pancreatectomy

ObjectiveTo investigate the feasibility and safety of spleen-preserving distal pancreatectomy (SpDP), and to discuss the indications and techniques of SpDP. MethodsThe clinical data of seven patients underwent SpDP between January 2004 and December 2007 in Xinhua Hospital were analyzed retrospectively. ResultsOut of the seven cases, one case received the SpDP combined with partial splenic vessel resection, while the other cases received the SpDP with splenic vessel preservation. The operation time was (2.93±0.38) h and the intraoperative blood loss was (392.86±109.65) ml. Only one case suffered from pancreatic fistula, who finally recovered after medicine therapy and percutaneous drainage. There was no other complication or operative mortality. The postoperative platelet count was (273±43.76)×109/L and the postoperative hospital stay was (17.86±8.07) d. For six cases of patients, no recurrence and metastasis was found after the followup (49.2±14.4) months （30-72 months）. ConclusionSpDP is a safe and feasible procedure, which is worthy for selected cases such as benign neoplasm of the body and tail of the pancreas.

胰腺炎脾血管并发症的解剖与诊断进展

胰腺炎脾血管并发症是较为常见的胰腺炎血管并发症，其发生率虽不高，却是胰腺炎病情重危程度、预后不良的征象之一，如脾动脉假性动脉瘤破裂可危及患者的生命。因此对于胰腺炎脾血管并发症的准确诊断就显得特别重要。超声作为急性胰腺炎检查中最常用的手段，由于易受胃肠道麻痹致腹内胀气、腹膜后血管彩色血流衰减、检查者经验和手法等原因的影响，导致超声对于胰腺炎脾血管并发症的诊断准确率较低。现通过文献复习，对该病的发生、发展以及诊断的进展进行综述，以提高超声医师对该疾病的认识，提高诊断的准确性。

Diagnosis and Treatment of Primary Splenic Tumor (Report of 22 Cases）

目的　 探讨脾脏原发性肿瘤的诊断与治疗方法。方法　对我院1996～2003年收治的22例脾脏原发性肿瘤患者的临床资料进行回顾性分析。结果　22例患者临床症状无特异性，术前均行B超检查，发现脾大21例，提示脾脏占位病变19例，该19例行CT检查，均发现脾大并提示有占位病变。手术病检证实良性肿瘤12例，恶性肿瘤10例。22例患者均行脾切除，其中有5例行淋巴结清扫，2例行侵犯脏器联合切除。结论　脾脏原发性肿瘤术前诊断主要靠B超、CT，其治疗首选外科手术。

Discussion and clinical application experience of laparoscopic spleen-preserving distal pancreatectomy technology

ObjectiveTo summarize the key technical points, applicability, feasibility, and safety of laparoscopic spleen-preserving distal pancreatectomy (LSPDP).MethodA retrospective analysis was performed for the clinical data of 22 patients who were admitted to the Affiliated Hospital of North Sichuan Medical College from September 2016 to November 2019, all patients planned to receive LSPDP.ResultsTwenty of the 22 patients successfully completed LSPDP, and 2 patients converted to laparotomy. One patient was transferred to laparotomy to suture the damaged splenic artery. The spleen was observed to have no ischemia and the spleen preservation operation was continued. One patient was converted to laparotomy due to the difficulty of dissecting the tail of the pancreas which caused by severe abdominal adhesion. The operation time of LSPDP patients was (191±86) minutes (170–480 min), intraoperative blood loss was (365±50) mL (200–1 000 mL), and postoperative hospital stay was (9.9±2.6) days (7–16 d). Six patients of pancreatic fistula occurred after operation, including 3 cases of biochemical fistula, which were cured and discharged after symptomatic treatment, 3 cases of grade B pancreatic fistula, who all improved after anti-inflammatory, acid suppression, enzyme suppression, and double catheter drainage. Twenty patients were interviewed after the operation, and the follow-up time was 3–24 months (median of 15 months). During the follow-up period, no patient had recurrence or metastasis.ConclusionsUnder the conditions of strict screening of suitable cases, adequate preoperative imaging evaluation, intraoperative fine manipulation, and the application of appropriate operating instruments and cutting closure devices, LSPDP is safe and feasible to treat benign tumors of the pancreatic body and tail and some borderline tumors. During the operation, attention should be paid to the reasonable treatment and protection of splenic arteries and veins.

Comparison of Curative Effect Between Laparoscopic Spleen-Preserving Distal Pancrea-tectomy and Laparoscopic Distal Pancreatectomy with Splenectomy for Occupancy Lesions in Pancreatic Body and Tail

ObjectiveTo explore the security and advantages of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) for occupancy lesions in pancreatic body and tail. MethodsA total of 97 patients with occupancy lesions in pancreatic body and tail who underwent laparoscopic distal pancreatectomy in our hospital from June 2010 to August 2014 were collected retrospectively, and were divided into LSPDP group (n=60) and laparoscopic distal pancreatectomy with splenectomy (LDPS) group (n=37) according to the surgery, clinical effect was compared between the 2 groups. ResultsThe operations got well in all patients, no one died during perioperative period. The operation time was shorter in LSPDP group than that of LDPS group[(190.83±66.39) min vs. (224.46±83.23) min, P=0.030], but there was no significant difference between LSPDP group and LDPS group in the blood loss[45.35 mL vs. 54.92 mL], hospital stay[(8.38±4.06) d vs. (9.76±4.54) d], incidence of total postoperative complication[23.33% (14/60) vs. 13.51% (5/37)], and degree of postoperative complication (P>0.050). There were 86 patients were followed up for 3-54 months, with the median time of 18 months. For patients with tumor, no one suffered from recurrence, metastasis, and death during the follow-up period, and other patients with benign diseases had an excellent prognosis. ConclusionFor occupancy lesions in pancreatic body and tail, LSPDP is feasible and safe.