胃肠手术中医源性脾损伤27例临床分析

Clinic analysis of iatrogenic splenic injury in gastrointestinal operation( 27 cases)

目的探讨胃肠手术中脾脏损伤的发生原因及防治措施。方法回顾分析2009年1月至2013年12月在昆山市第一人民医院行腹部手术中脾脏损伤的病例资料27例,按照我科制定的标准将其分为Ⅰ、Ⅱ、Ⅲ三类,针对三类不同程度的损伤,分别采用电凝法、缝合修补法、脾门损伤修补缝合法进行处理。结果该组27例发生于胃部手术20例,结肠手术5例,直肠手术2例,其中Ⅰ类损伤患者15例,Ⅱ类损伤患者8例,Ⅲ类损伤患者4例,经过相应的处理方法,所有患者均经手术治愈,无脾脏切除病例,且术后均未出现与脾脏损伤相关的并发症。结论医源性脾损伤的预防很重要,根据脾脏损伤情况分类,选择相应的处理方式,保脾是可行的。

Objective To investigate the causes and measures of prevention and treatment of splenic injury in gastrointestinal operation. Methods Retrospectively analyzed the datas of 27 cases of patients who suffered from splenic injury in gastrointestinal operation during January 2009 and October 2013 in our Hospital.According to classification standard which we designed,all the cases were divided into Ⅲ classes. For different classification,electrocoagulation,suture repair and repair of splenic hilus were adopted. Results The 27 cases of splenic injury were complicated by stomach operation（ account for 20 cases）,colon operation（ account for 5cases） and rectal operation（ account for 2 cases）. There were 15 cases of classⅠ injury,8 cases of classⅡ injury and 4 cases of class Ⅲ injury,and all the patients were cured after different treatments,no patient received splenectomy. None of the patients suffered from spleen damage related complications. Conclusions Preventing iatrogenic splenic injury from occurring is very important,according to the classification of splenic injury,selecting the corresponding treatment mode can save spleen from excision.