外伤性脾破裂的治疗:附208例报告

Treatment of traumatic rupture of the spleen:a report of 208 cases

目的探讨外伤性脾破裂治疗中保脾技术的临床应用。方法回顾性分析近10余年收治的208例脾外伤患者的临床资料。其中非手术治疗20例;采用保脾手术治疗88例,包括20例单纯脾修补,48例施以脾动脉结扎和/或脾部分切除和/或脾修补术,20例脾切除术后自体脾移植;100例脾门及附脾多处破裂者行脾切除术。结果108例保脾患者经手术或非手术治疗后,其IgM,CD3+远高于切脾组,差异有显著性(P<0.01);CD8+和CD4+显著高于切脾组(P<0.05),痘痕红细胞百分率低于切脾组(P<0.01)。CT,B超,99锝核素显像等证实保脾组1个月后脾结构恢复正常,裂口创面完全愈合。结论大部分外伤性脾破裂患者可采用保留脾治疗,术后脾结构和功能均可恢复正常。

Objective To evaluate the application of the spleen-preservation technique in splenic injury. Methods The clinical data of 208 ,cases with splenic trauma were analysed retrospectively. There were, 20 cases treated with non-surgical therapy; 20 cases treated with simple splenorrhaphy, 48 cases with ligation of splenic artery, splenorrhaphy and/or partial splenectomy, 20 treated with splenectomy and autologous spleen transplantation, and 100 cases with simple splenectomy. Results In 108 splenic preservation cases, who were operated or non-operated （SP group ） , the value of lgM and CD3 was significantly higher than that in the splenectomy group （ P 〈 0.01 ） ; CD8 and CD4 were significantly higher that those of splenectomy group （ P 〈 0.05 ） ; the percentage of pockmark red cells was lower than that splenectomy group （ P 〈 0.01 ）. CT, BUS and 99mTc nuclide scan confirmed that the structure of the preserved spleen had recovered to normal, and the ruptured surface of the spleen had completely healed I mouth after operation. Conclusions Most cases of traumatic rupture of spleen can be treated by splenic preservation methods, and the splenic structure and function can recover to normal postoperatively.