外伤性脾破裂保脾治疗的可行性及安全性分析

Practicability and safety of the spleen-retaining for traumatic splenic rupture

目的探讨外伤性脾破裂保脾治疗的可行性与安全性。方法对1998年7月至2005年7月收治的24例外伤性脾破裂患者,采用了保脾治疗:非手术保守治疗9例,保留脾手术15例,其中单纯粘合胶止血1例、单纯脾动脉结扎2例、单纯缝合修补3例、脾动脉结扎加脾修补4例、缝合修补加粘合胶止血2例、脾脏网兜捆扎术1例、脾部分切除术2例。结果在9例行非手术保守治疗中,有7例保守治疗成功,均痊愈出院,2例在保守治疗中转脾切除;15例保脾手术中2例因术后发生大出血而再次行脾切除术,其中1例抢救无效当时死亡。13例手术保脾成功,平均住院时间为13d。无其他合并症。结论外伤性脾破裂保脾治疗是可行的,但有一定风险,必须严格手术指征,手术方式依脾损伤分级或程度选择最佳术式,确保手术安全,术后应严密观察。

Objective To study the practicability and safety of the spleen - retaining for traumatic splenic rupture. Methods Twenty - four patients with traumatic splenic rupture to retain the spleen treatment in our hospital from July 1998 to July 2005,9 cases unnon - hand surgical operation, 15 cases did surgical operation to retain the spleen, among them, 1 case simply reed the gum to stick the wound of the splenic rupture ,2 cases pure ligated the spleen artery,3 cases simply sewed up to repair the wound of the splenic rupture ,4 cases ligated the spleen artery add repair the wound of the splenic rupture,2 cases sewed up to repair the wound of the splenic rupture add to use the gum to stick the wound of the splenic rupture, 1 case used the net bag to bind the spleen, 2 cases underwent part excision of spleen. Results In the 9 cases non - surgical operationses , under medical treatment there were 7 conservative successfully, completely recovered hospital discharge,2 cases under medical treatment were turned the spleen excision. In 15 reservations spleen surgical operation,2 cases went the spleen excision surgical operation again because took place the big issue post - operation, 1 patient was invakid to die at that time. Thirteen cases reserved the spleen of surgical operation successfully, average hospitalization time was 13 days. There was no other merger diseases. Conclusion To retain the spleen after traumatic splenic rupture treatment is viable, but have certain risk, It must be strict the surgical operation points to advertise for, the surgical operation method depends on the ratings or degrees of the spleen harm to, insuring the surgical operation safety. After operation should be observe tightly.