基层医院外伤性脾破裂46例诊治体会

Experience in diagnosis and treatment of 46 patients with traumatic splenic rupture in primary hospital

目的探讨外伤性脾破裂的诊断和治疗方法,提高救治水平。方法回顾性分析46例外伤性脾破裂的临床资料、治疗方法及其效果。结果 46例结合临床及辅助检查均明确诊断。3例经非手术治疗,5例行脾修补,3例行脾部分切除,29例行脾全切加自体脾移植术,6例行单纯脾切除术。治愈45例(97.83%),死亡1例(2.17%)。结论详细询问病史、仔细体格检查、反复多次腹腔穿刺及B超检查等均能提高脾破裂诊断率;外科手术是外伤性脾破裂的主要治疗方法,而行脾全切加自体脾组织移植术是基层医院选择的主要术式。

Objective To investigate the diagnosis and treatment of traumatic splenic rupture and improve the level of rescue and treatment. Methods The clinical data, treatment methods and effects of 46 patients with traumatic rupture were retrospectively analyzed. Results Forty-six patients were diagnosed clearly by clinical and laboratory examinations ;3 patients were cured by conservative treatment, 5 patients underwent splenic repair;3 patients underwent partial splcnectomy, 29 patients underwent whole splenectomy plus autologous spleen transplantation, 6 patients underwent whole splenectomy alone. 45 patients were cured （97. 83% ） and 1 patient died （2. 17% ）. Conclusion Detailed history, careful physical examination, peritoneocentesis repeatedly and ultrasonic diagnosis can in- crease the diagnosis rate of splenic rupture. It is necessary to choose the treatment methods rationally according to the degree of splenic injury and clinical manifestations. Surgical treatment is the main treatment method and the whole splenectomy plus autologous spleen transplantation is the main surgery pattern of traumatic splenic rapture in primary hospital.