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Non-Operative Management of Splenic Injuries （Report of 88 Cases）

目的　探討非手術治療外傷性脾破裂的可行性及適應證。 方法　回顧分析1998年以來山東省聊城市第二人民醫院非手術治療88例外傷性脾破裂的臨床資料及其治療效果。結果　88例均經B超檢查確診脾破裂，Ⅰ級損傷19例，Ⅱ級損傷57例，Ⅲ級損傷12例，其中16例患者合并肋骨骨折，11例合并肝外傷，9例合并腎挫傷，4例合并顱腦損傷，3例中轉手術。結論　有選擇地采用非手術治療外傷性脾破裂安全、有效，輕度的肝腎損傷、腹腔外器官合并傷及患者的年齡并不影響非手術治療的療效。

Spleen Traumatic Rupture Treated by Ligature of Splenic Artery Combined with Partial Splenectomy

目的 總結應用脾動脈結扎加脾部分切除術治療外傷性脾破裂的臨床經驗。方法 對本院近8年間收治的64例接受脾動脈結扎加脾部分切除治療的脾外傷患者的臨床資料進行回顧性分析，重點分析脾部分切除術的手術方法、臨床療效和適應證。結果 術中雙重結扎脾動脈，然后根據脾臟損傷的情況決定保留脾臟的部位，保證殘脾不少于原脾體積的30%。全組無手術死亡病例，術后出現早期并發癥者16例（25.0%），其中發熱8例，脾窩積液1例，腸梗阻2例，左側胸腔積液3例，切口感染2例，均經對癥處理后治愈。結論 對部分外傷性脾破裂患者的治療選擇脾動脈結扎加脾部分切除術是安全可行的。

Diagnosis, Treatment and Prevention of Rebleeding after Splenectomyc

目的 探討脾切除術后再出血的原因及診治方法并總結其預防措施。方法 對我院1998年8月至2009年3月收治的11例脾切除術后再出血患者的臨床資料進行回顧性分析。結果 本組11例再出血患者均行急診再手術治療，10例治愈,無術后并發癥，恢復順利，切口愈合良好，均拆線出院，術后住院10～21 d（平均15 d）； 余1例外傷性脾破裂者術中探查為胃短動脈破裂出血，遂結扎胃短動脈，術后發生胃瘺，經禁食、靜脈營養等治療，效果差，于術后20 d死亡。結論 脾切除術后再出血原因較多，以胃短血管處理不當、脾蒂血管結扎線脫落、胰尾部血管損傷及患者凝血功能障礙為主。脾切除術后出血以預防為主，術前充分做好各項準備，術中止血徹底，術后特別是術后24 h內嚴密觀察腹腔引流液的量、性質及速度。再出血后果嚴重，一旦發生，應及時準確診斷，行急診再手術治療。

Research of Changes of Platelet Count after Splenectomy in Patients with Splenic Rupture or Cirrhosis

Objective　To compare the difference of the changes of platelet counts after splenectomy between the patients with splenic rupture and patients with cirrhosis and portal hypertension, and to analyze the possible reasons and clinical significance. Methods　The platelet count of 47 splenic rupture patients and 36 cirrhosis patients who had been carried out splenectomy from July 2008 to December 2009 in our hospital were counted, and the differences in platelet count and it’s change tendency of two groups were compared. Results　In the splenic rupture group，the platelet count of all 47 patients increased abnormally after operation, the maxlmum value of platelet count among 300×109/L-600×109/L in 6 cases，600×109/L-900×109/L in 21 cases，and above 900×109/L in 20 cases. In the cirrhosis group，the maxlmum value of platelet count after operation was above 300×109/L in 26 cases，100×109/L-300×109/L in 8 cases，and below 100×109/L in 2 cases. The difference of maxlmum value of platelet count in the two groups had statistic significance（P=0.00）. Compared with the cirrhosis group, the platelet count increased more significant and decreased more slow in splenic rupture group（P＜0.05）.The abnormal days and rising range of platelet count were higher in patient with Child A than Child B and C（P=0.006，P=0.002）. Conclusions　The change of platelet count after operation in splenic rupture group was obviously different from cirrhosis group because of the difference of the liver function and body situation of patients. To patients with splenic rupture or cirrhosis, appropriate treatment based on the platelet count and liver function could obtain good therapeutic effect.

臨時控制性脾動脈結扎聯合脾修補術治療外傷性脾破裂36例報道

目的探討臨時控制性脾動脈結扎聯合脾修補術治療外傷性脾破裂的手術效果及對脾臟正常血供的影響。 方法將我院2004年12月至2014年12月期間所做的臨時控制性脾動脈結扎加脾修補（研究組，n=36）與單純性脾修補患者（對照組，n=36）的臨床資料進行回顧性對比分析。 結果2組均治愈出院。研究組的平均引流管拔除時間明顯早于對照組（P=0.000），研究組的平均總引流量也明顯少于對照組（P=0.000）；2組手術時間、住院時間及術后總并發癥發生率比較差異無統計學意義（P＞0.05）。所有并發癥均經抗炎、胸腔穿刺抽液、切口引流加壓包扎及對癥治療后獲愈。 結論臨時控制性脾動脈結扎加脾修補治療的臨床療效優于單純性脾修補手術，并且避免了永久性脾動脈結扎對脾臟遠期主干血供的影響。

14例脾修補及脾動脈結扎治療外傷性脾破裂的臨床觀察

外傷性肝脾破裂48例報告

Application Experience of Laparoscopic Splenectomy in Patients with Traumatic Splenic Rupture

ObjectiveTo investigate the safety and feasibility of the treatment of laparoscopic splenectomy for patients with traumatic splenic rupture. MethodsBetween October 2006 and October 2009, 48 cases of traumatic splenic rupture underwent laparoscopic splenectomy were analyzed in this hospital. According to the differrent styles of splenic stalk, different operative methods were taken， including titanic clipping in 12 cases， titanic clipping combining silk suture ligation in 8 cases， snare combining titanic clipping in 10 cases， LigaSure in 8 cases， and EndoGIA in 8 cases. ResultsLaparoscopic splenectomy was successfully completed in 32 cases; Handassisted laparoscopic splenectomy was applied in 14 cases, and 2 cases were converted to laparotomy because of tight spleen adhesion with surrounding tissues and bleeding rupture of the short gastric vessels. The operation time was 120－170 min with an average 140 min; the estimated intraoperative amount of blood loss was 300－1 200 ml with an average 800 ml. No postoperative complication occurred such as gastric fistula, pancreatic fistula or hemorrhage. Conclusion According to the differrent styles of splenic stalk, individual operative method can improve mission success rate in the laparoscopic splenectomy in traumatic splenic rupture.

外傷性脾破裂104例診治體會

SIMULTANEOUS LIGATION OF SPLENIC ARTERY AND VEIN FOR SEVERE TRAUMATIC RUPTURE OF SPLEEN

In order to preserve more normal tissue in situ in case of severe traumatic rupture of spleen, simultaneous ligation of splenic artery and vein was performed successfully on animals and then was applied for clinic use. The preserved splenic tissue all survivied and functioned well. Patients with severe traumatic rupture of spleen grade Ⅳ-Ⅴ were all cured by ligation of both the splenic artery and vein at the same time.