复杂性脾切除102例回顾性分析

Complex splenectomy:a retrospective analysis of 102 cases

目的总结复杂性脾切除的治疗经验。方法对1998年1月至2008年1月中南大学湘雅医院收治的102例复杂性脾切除病例进行回顾性分析。结果病人均痊愈出院,无手术死亡及胰漏和胃、结肠损伤。其中29例出现术后并发症:腹腔内出血4例;肺部并发症13例,其中8例左胸腔积液病人有7例合并左膈下脓肿;脾静脉栓塞性静脉炎6例;大量腹水6例。分别经再次手术或保守治疗后痊愈。结论完善的术前评估,规范的手术操作,正确的脾周粘连的解剖分离及脾蒂的处理,是确保复杂性脾切除安全的关键。

Objective To summarize the experience of complex splenectomy. Methods The clinical data of 102 cases of complex splenectomy from January 1998 to January 2008 at Xiangya Hospital of Central South University were analyzed retrospectively. Results All the cases were recovered and discharged. No cases of operative mortality, pancreatic leakage or gastric and colonic injury existed. The postoperative complications occurred in 29 cases including 4 cases of intra-abdominal hemorrhage, 13 cases of pulmonary complications （7 of the 8 left pleural effusion cases complicated with left subphrenic abscess）, 6 cases of splenic venous thrombophlebitis and 6 cases of mass ascites. All of them were cured by reoperation or conservative treatment. Conclusion The careful evaluation before operation, standardized operative procedure, correct skillful technics of the dissection for perisplenic adhesion and handling of splenic pedicle are the crucial factors determining the safety of complex splenectomy.