外伤性脾破裂82例诊治分析

Diagnosis and treatment of traumatic splenic rupture:a report of 82 cases

目的总结外伤性脾破裂的诊治经验,以提高脾破裂的诊治水平。方法回顾性分析近13年来收治的82例外伤性脾破裂的诊断和治疗。结果根据外伤史、体格检查、诊断性腹部穿刺及B超、CT等检查,确诊率为95·12%。非手术治疗15例(18·29%),均治愈;手术治疗67例(81·70%),除3例患者术中死亡外,余均一期手术成功,痊愈出院。结论外伤病史的详细询问和体格检查、多部位反复的腹腔穿刺及必要的辅助检查是提高脾破裂确诊率的关键。外伤性脾破裂在确保伤者生命安全的前提下,应尽可能保留脾脏,尤其是儿童。脾修补加或不加脾动脉结扎是保脾治疗中较为简单、安全、有效的方法。

Objective To summarize our experiences in the diagnosis and treatment of traumatic splenic rupture（TSR）in order to improve the diagnosis and treatment level of TSR.Methods The diagnosis and treatment of 78 patients with traumatic splenic rupture in recent 13 years were retrospectively analyzed.Results The preoperative correct diagnosis rate was 95.12%and was established on the history of injury,clinical presentation,abdominal paracentesis,abdominal uhrasonography and CT.the 15 cases treated nonoperatively were cured,and the other 67 cases treated by operation.79 patients were cured and 3 cases were died during operation.Conclusion Combination of obtaining a detailed history of injury,physical examination,abdominal paracentesis,abdominal ultrasonography and CT can improve the accuracy rate of preoperative diagnosis.Under the ensurance of the safety of the patients life,preservation of the spleen should be performed if possible,especially for children.Both splenorhaphy with or without ligation of splenic artery are simple,safe and effective methods to salvage the spleen.