胃癌根治术中医源性脾脏损伤10例临床分析  

The analysis of 10 clinical cases with iatrogenic splenic injury in radical gastrectomy

作　　者：袁笑[1] 陈开伟[1] 郭涛[1] 徐阿曼[1] 

机构地区：[1]安徽医科大学第四附属医院普外科,合肥230022

出　　处：《肝胆外科杂志》2013年第6期442-443,共2页Journal of Hepatobiliary Surgery

摘　　要：目的探讨胃癌根治术中医源性脾脏损伤的原因、预防措施及处理方法。方法回顾性分析我院普通外科2009年1月至2012年12月262例胃癌根治术中发生的10例脾脏损伤患者的临床资料。结果胃癌根治术中脾损伤的发生率为3.8%(10/262),本组10例中,脾下极脏面撕裂4例,脾上极脏面撕裂3例,脾体部裂伤2例,脾门撕裂1例;按2000年中华医学会外科分会脾脏外科学组"脾脏损伤程度分级"标准,Ⅰ级损伤7例,Ⅱ级损伤2例,Ⅲ级损伤1例。其中,7例应用局部止血措施,2例行脾修补术,1例行脾切除术。全组未出现与脾损伤相关的并发症,均治愈出院。结论普外科医师在手术之前应充分评估患者情况,包括患者年龄、病变部位等,制定适宜的手术方案;手术过程中要提高防范意识,尤其是胃底部肿瘤切除或全胃切除时要注意保护脾胃韧带;另外,开腹探查后就切断脾门到脾下极间附着的纤维束带为可借鉴的手术技巧。对于裂口小而浅的Ⅰ级脾损伤压迫止血后可不缝补,Ⅱ级脾脏损伤可行脾修补术或部分切除术,对于严重破裂而无法保留脾脏者,可行全脾切除。Objective To investigate the reasons of iatrogenic splenic injury in radical surgery of gastric cancer and subsequent measures of prevention and treatment.Methods A retrospective analysis was conducted with the clinical data of 10 cases of iatrogenic splenic injury among 262 patients in gastric cancer from January 2009 to December 2012 in our hospital.Results The prevalence of iatrogenic splenic injury was 3.8 percent.Among ten cases,According to Pachter grade for splenic injury,seven cases were in grade Ⅰ,2 cases were in grade Ⅱ,and 1 cases was in grade Ⅲ.Spleen-preserving successful in 25 cases full-splenectomy in 5 cases.All patients recovered and discharged.Conclusion latrogenic splenic injury caused by radical surgery of gastric cancer is a common complication.Good anesthesia and careful operation can effectively prevent and reduce the incidence of iatrogenic splenic injury.

关 键 词：胃癌根治术 医源性脾损伤 预防 处理 

分 类 号：R658[医药卫生—外科学]