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。
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.
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.
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.
目的探讨腹腔镜技术在治疗外伤性脾破裂中的可行性和安全性。 方法回顾性分析笔者所在医院2012年3月至2014年3月期间应用腹腔镜技术救治的19例外伤性脾破裂患者的临床资料。 结果本组19例患者中，顺利完成腹腔镜手术17例，中转开腹2例，均获得成功救治，痊愈出院。其中行腹腔镜下电凝止血＋生物蛋白胶黏合保脾4例，行腹腔镜下无损伤线缝合＋网膜覆盖保脾8例，行腹腔镜脾切除术5例，中转开腹行脾切除术2例。手术时间50～186 min，平均90 min；术中失血250～2 200 mL，平均780 mL；术后住院时间7～26 d，平均13.5 d，术后均无并发症发生。术后19例患者均获访，随访时间为3～12个月，平均8个月。随访期间无死亡及远期并发症发生。 结论对外伤性脾破裂患者选择性施行的腹腔镜脾修补术和脾切除术具有良好的效果，其具有创伤小、痛苦轻及恢复快的优点，安全而可行，值得推广。