脾切除手术指征及近期疗效分析

Indications for Splenectomy and Short-term Results Analysis

【目的】分析总结脾切除手术的近期疗效以提高其安全性、降低死亡率 ,减少并发症并指导正确掌握切脾适应征。【方法】统计 430例脾切除手术病人的临床资料 ,包括切脾指征、手术种类、术后并发症和手术死亡率。【结果】切脾指征中的原发疾病以肝为最多 192例 (4 4% ) ,尤其是门脉高压性脾亢 16 4例 (38% ) ;430例患者共行 76 8例次不同类型的手术 ,除切脾外 ,以分流断流为最多 75例次 (2 3% ) ;术后发生 111例次并发症 (2 6 % ) ,以感染为最多 (12 % ) ,术后死亡 12人 ,术后受治病死率 2 %。【结论】认识脾的免疫功能 ,正确掌握适应征和加强围术期处理是提高脾切除手术安全性的关键。

Objective To summarize the short-term results of splenectomy operations in order to increase the operative security, decrease the operative morbidity and mortality and correctly master the indications of splenectomy. Methods The authors collected the clinical data of 430 cases of patients underwent splenectomy,including indications of splenectomy, the types of operation, post-operative morbidity and mortality. Results The most of patients indicated for splenectomy were hepatic diseases (192 cases, 44%), especially for portal hypertension splenomegaly (164 cases, 38%); 430 cases underwent 786 different types of operation, beside the splenectomy, most of them were portacaval shunt or esophagogastric devascularization (75 cases/times, 23%), 111 patients experienced post-operative complications (26%), most of them were infections (12%), 12 patients died (mortality 2%). Conclusion The major deciding factors in increasing the security of splenectomy are knowing splenic immune functions, mastering indications of splenectomy and appropriately management of patients peri-operatively.