312例创伤性脾破裂的诊治经验

Diagnosis and treatment of traumatic spleen rupture in 312 consecutive cases

目的总结创伤性脾破裂的诊治方法与经验,提高救治成功率,有效降低治疗风险。方法回顾性分析1996～2011年间我院收治的312例创伤性脾破裂患者的诊断与治疗,对治疗结果进行分析总结。结果根据病史、临床表现、体格检查及相关辅助检查等,诊断正确299例,诊断符合率为95.8%。本组非手术治疗25例,2例中转为手术,2例因病情危重死亡。手术治疗289例,治愈271例。全组共治愈296例,治愈率为94.9%。死亡16例,死于出血性休克和多发脏器损伤。结论创伤性脾破裂行脾切除术疗效较好,死亡和并发症发生率低,对重度失血性休克和严重多发伤患者应采取更积极的外科治疗策略。非手术治疗应掌握严格的适应症。

Objective To summarize the experience in the diagnosis and treatment of traumatic spleen rupture. Methods Diagnosis and treatment of consecutive 312 patients with traumatic spleen rupture from January 1996 to October 2011 were reviewed. Results The diagnosis was established by the history of injury, clinical presentations, diagnostic peritoneal punctures, abdominal ultrasonography and / or CT. The accuracy rate of diagnosis was 97.6%. 25 patients were treated nonoperatively and cured. 289 patients treated operatively were cured. 16 patients died of controllable hemorrhage or severe multiple injuries. Conclusions Splenectomy for the treatment of traumatic spleen rupture is satisfactory. The morbidity and mortality of spleneetomy is low.