外伤性脾破裂保脾方法的选择(附46例报告)

Methods of preserving spleens in traumatic splenic rupture( a report of 46 cases).

目的探讨外伤性脾破裂保脾方法的选择。方法回顾性分析进行保脾治疗的46例外伤性脾破裂患者的临床资料。结果非手术治疗成功率79.3%(23/29),非手术治疗占同期脾外伤的20%。手术保脾治疗17例,其中单纯修补缝合3例,脾修补缝合加大网膜填塞3例,脾部分切除加大网膜填塞修补3例,全脾切除加脾组织大网膜移植8例。血管介入脾动脉栓塞治疗6例,均一次脾动脉栓塞成功。46例均无并发症发生。痊愈45例,1例因合并颅脑损伤呈植物状态。结论脾脏Ⅰ级损伤以非手术治疗为主,Ⅱ级损伤以脾动脉栓塞或手术修补保脾为主,Ⅲ级以上的损伤只能手术保脾,同时结合实际情况进行个体化和综合治疗。

Objective To explore the method of preserving spleens in traumatic splenic rupture.Methods Clinical data of 46 cases with preserving spleens treatment were reviewed retrospectively.Results Non operative therapy rate accounted for 20% in the treatment of all traumatic spleen and the successful rate was 79.3%(23/29).17 patients were treated surgically for preserving spleen,of whom 3 with suture and omentum tamping,3 with splenic part excision and omentum tamping and 8 with total spleen excision and autotransplantation in major omentum.6 cases were treated successfully by embolization of spleen artery.There was no complication in 46 cases.45 cases were cured and 1 case was in plant status for craniocerebral injury.Conclusion Splenic injuries with grade Ⅰ and Ⅱ may be given priority to nonoperative treatment and splenic artery embolization or repairing preserving spleen respectively.Splenic trauma with grade Ⅲ or more should be treated surgically with preserving spleen.Simultaneously,therapeutic methods should be chosen individually and comprehensively.