脾周韧带对脾破裂腹腔积血解剖分布的影响:超声-解剖学研究

Effects of perisplenic ligaments on anatomic distribution of hemoperitoneum after splenic rupture: anatomic-sonographic study

目的 探讨脾破裂后腹腔积血的超声表现及其优势解剖分布与脾周韧带解剖特点的关系。方法 收集超声资料完整且经手术证实的脾破裂并有腹腔积血病例 38例,观察和分析其腹腔积血的解剖分布特点,并观察 4例尸体横断面标本脾周韧带的组成、位置及与脾脏的附着关系。结果 腹腔积血常累及右肝下间隙 (92. 1% )、脾周 (86. 8% )、右结肠旁沟(57. 9% )及盆腔(63. 2% ),较少累及网膜囊(2. 6% )及左结肠旁沟 (21. 1% )。尸体横断面标本上,胃脾韧带、脾肾韧带分别为联系脾门与胃底、脾门与肾的腹膜反褶,并构成网膜囊的左壁,膈结肠韧带位于脾脏下方。结论 脾破裂腹腔积血的优势解剖分布与脾周韧带解剖特点、腹腔压力分布及病人的体位等因素有一定关系。超声检查能够了解出血的分布、范围、量,对脾损伤的诊断具有一定价值。

Objective To ascertain the sonographic features of hemoperitoneum after splenic rupture, and to analyze the relationship between dominant anatomic distribution of hemoperitoneum and anatomic characteristics of perisplenic ligaments. Methods Ultrasound manifestations of hemoperitoneum resulting from splenic rupture in 38 cases confirmed by operation were retrospectively reviewed and analyzed in regard to distribution and volume. Four cadavers were cut transversely. The form and the position of perisplenic ligaments were observed. Results The right subhepatic space (92.1%), the perisplenic space (86.8%), the right paracolic gutter (57.9%) and the pelvic cavity (63.2%) were usually involved in the hemoperitoneum, while the omental bursa (2.6%) and the left paracolic gutter (21.1%) were seldom involved. On cadaver sections, the gastrosplenic ligament and the lienorenal ligament were peritoneal reflections between hilus of spleen and fundus of stomach, and between hilus of spleen and left kidney respectively. The left wall of omental bursa was composed of lienorenal ligament and gastrosplenic ligament. Conclusion The dominant anatomic distribution of hemoperitoneum resulting from splenic rupture has relation to the anatomic characteristics of perisplenic ligaments, the distribution of abdominal pressure and the posture of patients. Ultrasound is a helpful tool in detection of distribution and volume of hemoperitoneum.