脾损伤采用保脾技术的基础和临床应用研究  

Experimental and clinical studies on treatment of splenic injury with spleen-preservation techniques

作　　者：马宏敏[1] 蔡志民[1] 杨新华[1] 

机构地区：[1]第三军医大学西南医院普外科,重庆400038

出　　处：《中华肝胆外科杂志》1998年第3期142-144,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的通过系列的动物实验和临床研究,达到在脾损伤时采用多种方法保留脾功能。方法在动物实验成功的基础上,应用保脾术于临床,近20年我们收治脾损伤263例,其中全脾切除83例(31.56%);采用多种保脾技术180例(68.44%)。后者行切脾后自体脾移植90例,脾修补和部分切除45例,脾动脉单纯结扎或保留副脾10例,非手术疗法保脾35例;脾修补的方法是用4号丝线作褥式或间断缝合;脾移植是取脾的25%切成1cm×1cm×0.5cm 块状,植入网膜袋中。结果保脾组死亡6例,占手术保脾组的4.14%,死因与保脾技术无关。存活的保脾病例随访最长15年,B 超和核素锝扫描显示术后3个月脾修补裂伤愈合,脾移植的脾块显像良好;脾移植与全脾切除比较,血清Tuftsin 显著上升,痘痕红细胞计数明显下降。结论临床上采用的多种保脾技术,包括自体脾移植均能恢复脾的生理功能。Objective To explore spleen-preservation methods and their effects.Methods Spleen-preservation techniques were applied to the patients with splenic injury on the basis of successful animal experiments.Of the 263 patients with splenic injury treated in our departmnet in the past 20 years,83(31.56 %)received total splenectomy,while 180(68.44 %)were treated with spleen-preserva- tion therapy.Of the latter,90 were treated with autoplasty of spleen,45 with splenorrhaphy and partial splenectomy,10 with simple ligation of splenic artery and preservation of accessory spleen,35 without any operation.As for the methods of operations,we selected mattress suture or interrupted suture with 4~# silk 10 repair the ruptured spleen or transplanted a quarter of the original spleen into omental bursa after cutting the splenic tissue into 1cm×1cm×0.5cm-sized masses.Results It was not due to splenic preservation that 6 patients(4.14%)underwent spleen-preservation operation died.The longest time of follow-up survey on the spleen-preserved patients was 15 years.Three months after the operation,B mode ultrasonography and nuclide scintiscanning showed that the splenic laceration was healed and the autotransplanted spleen exhibited good scintigram.The average value of serum tuftsin was significantly higher but the count of packed red cells was lower in patients with splenic autotransplantation than in those with total splenectomy.Conclusion The above-mentioned spleen-preservation methods,includ- ing splenic autotransplantation,can restore the physiological functions of spleen.

关 键 词：保脾技术 脾损伤 脾修补 自体脾移植 临床应用研究 全脾切除 动物实验 生理功能 存活 红细胞计数 

分 类 号：R657[医药卫生—外科学] R733.2[医药卫生—临床医学]