腹部手术中脾损伤的处理对策

Prevention and treatment of iatrogenic splenic injury in abdominal operation

目的探讨术中医源性脾损伤的预防措施和处理对策。方法回顾性分析1990年5月至2010年5月腹部手术中脾损伤18例的临床资料。结果18例中，发生于胃十二指肠手术12例（66．7％），结直肠手术3例（16．7％），胰腺手术1例（5．5％），剖官产术2例（11．1％）。行脾切除术5例，脾部分切除术2例，脾修补术5例，局部止血术6例。17例术中即时发现处理，治愈出院，无并发症；1例脾破裂术中未发现，术后第1天因休克而获诊，再次手术行脾切除术，术后死于急性肾功能衰竭。结论医源性脾损伤可以预防，术中正确处理脾损伤是治疗的关键。

Objective To explore the strategies of prevention and treatment of intraoperative iatrogenic splenic injury. Methods Between May 1990 and May 2010 the clinical data of 18 patients with iatrogenic splenic injury during abdominal surgery were analyzed retrospectively. Results Iatrogenie splenic injury occurred in gastroduodenectomy （66. 7 % ）, colorectectomy （ 16. 7 % ）, pancreatectomy （5.5 %） and hysterotokotomy （11.1 %）. Five cases were subjected to splenectomy, 2 cases to partial splenectomy,5 cases to splenic suture operation and 6 cases to local hemostasis. Seventeen cases were treated promptly during the operation and cured. Intraoperative splenic rupture wasn＇t found in one case,and diagnosed due to shock on the postoperative day one. The patient died of acute renal failure after splenectomy was done in the reoperation. Conclusion Iatrogenic splenic injury can be prevented. Handling properly splenic injury during the operation is the key of treatment.