腹腔镜治疗外伤性脾破裂51例报告  

Laparoscopic treatment of traumatic splenic rupture: a report of 51 case

作　　者：张子通[1] 赵曦[1] 莫伟峰[1] 

机构地区：[1]广东医学院附属厚街医院,广东东莞523945

出　　处：《腹腔镜外科杂志》2015年第3期212-214,共3页Journal of Laparoscopic Surgery

摘　　要：目的:总结腹腔镜手术治疗外伤性脾破裂的手术经验及临床价值。方法:回顾分析2004年1月至2013年12月为51例外伤性脾破裂患者行腹腔镜手术的临床资料。结果:31例行脾切除术(其中13例于脾脏切除后脾片自体移植),2例行脾部分切除并脾蒂血管选择性结扎,13例行脾脏修补术,5例中转开放手术。手术时间平均(126±32)min,其中腹腔镜脾切除术平均(94±21)min,脾修补术平均(150±13)min。术中探查腹腔积血量平均(560±457)ml,脾脏修补合并肝脏破裂的患者于术后2周下床,脾切除未合并肝肾挫伤的患者术后下床时间平均(1.5±0.2)d。术后肛门排气时间平均(2.0±1.3)d。2例脾切除患者术后当天出血,剖腹探查发现胃壁胃短动脉出血,缝扎后止血;1例脾静脉血栓经抗凝等治疗后缓解。患者均治愈出院,术后随访1年,未发现爆发性感染病例。结论:腹腔镜治疗外伤性脾破裂是安全、可行的,但需要术前评估脾脏破裂及患者全身情况,并进行个体化治疗,必要时应果断中转开放手术。Objective： To summarize the operative experience and clinical value of laparoscopic operation in the treatment of traumatic rupture of spleen. Methods： A retrospective analysis was made on the clinical data of 51 patients who suffered from traumatic rupture of spleen from Jan. 2004 to Dec. 2013 and underwent laparoscopic operation. Results： Thirty-one patients underwent splenectomy,13 patients of them received splenic auto-transplantation. There were 2 cases of partial splenectomy and selective ligation of spleen pedicle vessels,13 cases of splenic repair,5 cases conversion to open operation. The average operation time was（ 126 ± 32） min,average operation time of laparoscopic splenectomy was（ 94 ± 21） min,the average operation time of laparoscopic splenic repair was（ 150± 13） min. Intraoperative hemoperitoneum was（ 560 ± 457） ml. The ambulation time of patients with liver rupture and repair of spleen was 2 weeks,the ambulation time of splenectomy patients without hepatorenal contusion was（ 1. 5 ± 0. 2） d. Postoperative anal exhaust time was（ 2. 0 ± 1. 3） d. 2 splenectomy patients suffered from hemorrhage on the operative day,open exploration was performed and hemorrhage of gastric short artery on the gastric wall was found and treated by transfixion hemostasis. 1 case of splenic vein thrombosis relieved after anticoagulation therapy. All the patients were cured and discharged. After follow-up of 1 year,no fulminant infection was found. Conclusions： Laparoscopic treatment of traumatic rupture of spleen is safe and feasible,but surgeons should assess the rupture of the spleen and the general conditions of patients before operation,and perform individualized treatment,laparoscopy should be converted to laparotomy if necessary.

关 键 词：外伤性脾破裂 脾切除术 保留脾脏 腹腔镜检查 

分 类 号：R657.62[医药卫生—外科学]