86例脾破裂诊疗体会

Experience in Diagnosis and Treatment of Traumatic Rupture of Spleen in 86 Cases

目的探讨外伤性脾破裂的诊断和治疗。方法对86例外伤性脾破裂的诊断与治疗进行分析。结果外伤性脾破裂86例,男62例,女24例,手术治疗73例,保守治疗13例。86例患者痊愈出院,无死亡病例。结论详细询问病史,仔细体检,多部位反复腹穿,必要的辅助检查是减少脾破裂漏诊或误诊的主要因素。在急诊处理中,立即建立有效的静脉通道,及时抗休克治疗,保持呼吸道通畅并充分给氧是降低早期死亡的重要措施。外伤性脾破裂的治疗主张"保命第一,保脾第二"的原则,不轻易切脾,特别是小儿,但也不能盲目保脾。

Objective To investigate the diagnosis and treatment of splenic rupture.Methods Diagnosis and treatment of 86 cases with traumatic rupture of spleen were analysed retrospectively in this paper.Results The 73 patients of 86 cases with splenic rupture were treated conservatively and 13 cases underwent operation.The 86 patients completely recoverd,and with no deaths.Conclusion It points out that detailed medical history-taking,careful physical examination,repeated abdominal paracentesis at multiple sites,and necessary accessory examinations are the major factors for avoiding missed diagnosis or misdiagnosis.During emergent treatment,immediate establishment of effective venous passageway,timely carrying out antishock therapy,maintaining respiratory tract unobstructed,and supply of sufficient oxygen are important measures to be taken to reduce death in the early stage.The author holds that in treatment of traumatic rupture of spleen the principle of ＂life-saving first,spleen-preserving second＂ should be observed.The spleen should not be resected rashly,especially in children,while it should not be blindly reserved without indications.