脾切除术中大出血的预防及处理

The Prevention and Treatment of the Massive Haemorrhage in the Splenectomy

目的:探讨脾切除术中大出血的原因、预防及处理。方法:回顾性分析24例脾切除术中大出血病人的临床资料。结果:24例中脾切除术病人中强行分离脾周围粘连造成出血不止者10例,占41.7%(10/24)、盲目用手钝分离脾肾韧带造成大出血8例,占33.3%(8/24)、胃短血管撕裂3例,脾蒂过短,强行向外托出脾脏时用力过大撕裂脾蒂2例,脾蒂钳滑脱1例。经相应处理,本组无1例手术死亡。结论:脾切除术发生大出血时,原则上应先压迫控制出血并立即输血,然后将手术野作充分显露。根据出血的原因、部位在直视下做相应处理。

Objective：To probe into prevention and treatment of the massive haemorrhage in the spleneetomy. Methods-Tweenty- four cases with bleeding in splenectomy from januamy, 1994 to December 2004 were reviewed. Results：There were 10 patients （41.7%） whose adhesion around thd spleen was separated by force with bleeding endlessly and 8 patients （33.3%） whose ligaments of the spleen and kidney were separated bluntly by hand with massive haemorrhage. There were other 3 cases with the stomach short blood vessel torn,2 cases with the pedicle of spleen torn while holding out the spleen outwards greatly owing to the short pedicle of spleen and 1 case with the pliers of the pedicle of spleen taken off. Through corresponding process, there was none of death in all the cases above, Conclusion：The greatest dangerous in thd spleneetomy is the massive hemorrhage of the operation. When it takes place, in principle, we should first oppress and control the bleeding and transfuse blood immediately then make surgical operation well to correspond the prosess under direct view according to the reason and the location of bleeds.