外伤性脾破裂保脾治疗的解剖学依据

Anatomical Basis for the Protective Protective Procedures After Splenic Rupture

目的:分析外伤性脾破裂保脾治疗术式的解剖学依据及治疗效果。方法:根据脾脏的分叶、分段和分区指导临床判断外伤的类型;应用脾动静脉的分支类型和脾内动脉干及终支的解剖学特点为临床提供治疗方式。分析临床115例外伤性脾破裂保脾治疗成功的解剖依据及治疗方法。结果:单纯保守(非手术)治疗成功率41.7%(48/115),占同期脾外伤的33.8%(48/142);手术保脾治疗26例(22.6%),其中单纯修补缝合6例,脾修补缝合加大网膜填塞12例,脾部分切除加大网膜填塞修补8例;全脾切除加脾组织大网膜移植27例;脾动脉栓塞介入治疗31例(27.0%)。痊愈109例,2例因合并严重血气胸3,例合并多器官功能衰竭死亡1,例因合并颅脑损伤呈植物状态。结论:外伤性脾破裂患者,可根据脾脏解剖学的特点来分析和判断损伤类型,尽可能采用保脾方式治疗,减低伤残率。

Objective： To analyze the anatomic basis and treatment of spleen-preserving therapy methods in the traumatic splenic rupture.Method： According to the distribution of the leaf and segmentation of spleen,and the sub-section of leaf,segmentation and partition of spleen,it helped us determine the types of clinical traumas;application of the anatomical features of splenic artery trunk and the final branches,it provided for clinical treatment.To analyze the anatomical basis and the treatment ways in the successful spleen preserving treatment in the 68 cases of traumatic splenic rupture.Result： The successful rate of non-surgical treatment was 41.7%（48/115）,non-surgical treatment of splenic injury over the same period accounted for 33.8%（48/142）.Spleen-preserving surgical treatment of 26 cases,of which 6 cases of simple suture repair,spleen suture repair and omentum filled in 12 cases,partial removal of the spleen and omentum filled and repaired in 8 cases,total removal of the spleen and transplanted the splenic tissue in the omentum in 27 cases;interventional and embolization of splenic artery in 31 cases.109 patients recovered,two patients with severe hemothorax and pneumothorax,three patients died of multiple organ failure,and one case was in the plant-state because of the brain injury.Conclusion： Patients with traumatic splenic rupture,should be based on the spleen anatomical characteristics to analyze and determine the type of injuries;intake the preserving spleen treatment as far as possible and reduce disability rate.