外伤性脾破裂合并其他严重损伤的综合治疗

Comprehensive treatment of traumatic splenic rupture with severe combined injuries

目的探讨外伤性脾破裂合并其他严重损伤的诊断与治疗。方法分析32例外伤性脾破裂合并其他部位严重损伤的临床资料,其中行脾脏手术后再行其它合并伤的治疗17例;先行合并伤的手术治疗,再行脾脏手术11例;脾脏手术与合并伤的手术同时进行2例;合并伤手术治疗,脾脏损伤行保守治疗2例。结果治愈28例,好转转院2例,死亡2例。平均随访2.32年,术后恢复生活自理能力,无脾切除术后凶险感染发生。结论对外伤性脾破裂合并其他严重损伤患者,准确辨别危害生命的主要因素,抓住主要矛盾,制定合理的抢救治疗措施及程序,可显著提高患者救治成功率,降低病残、死亡率,改善患者的生存质量。

Objective To explore the diagnosis and management of traumatic splenic rupture with severe combined injuries. Methods A retrospective analysis of the clinical data of 32 patients with traumatic splenic rupture and other combined severe injuries was carried out. The splenetomy was done prior to the management of the combined injuries in 17 cases. The operations of the combined injuries were done prior to splenic operations in 11 patients, The operations of spleen and combined injuries were carried out simultaneously in 2 cases. And the splenic injuries were treated conserva- tively after the operation of combined injuries in another 2 patients. Results There were 28 patients who were cured, 2 transformed to large hospital after their condition getting stabIe and 2 dead. The average follow-up time was 2.32 years. All the patients recovered very well and were self-dependent without overwhelming post-spleneetomy infection. Conclu- sion It is very important to distinguish the primary factors which is about to endanger the life of the wounded in patients with the splenic rupture and other combined severe injuries. Taking close attention on the primary injuries and subsequent dysfunction, the rational rescue schedule and measures should be settled as soon as possible. Thus the successful recovery rate can be promoted significantly. And the mortality and morbidity can be decreased significantly also. The wounded will enjoy higher living quality as a result.