脾损伤保脾治疗方法的回顾性分析  

Retrospective Analysis on Spleen-preserving Treatment Methods for Patients with Splenic Injury

作　　者：王学文[1] 卿小松[1] 杨森[1] 赖钊[1] 

机构地区：[1]自贡市第四人民医院肝胆外科,四川自贡643000

出　　处：《华西医学》2015年第9期1641-1644,共4页West China Medical Journal

摘　　要：目的总结脾损伤保脾方式的治疗效果及成功率,探讨不同类型的脾损伤理想的保脾治疗方式。方法回顾性分析肝胆外科1998年7月-2010年12月收治的136例脾损伤行保脾治疗患者的临床资料,比较采用不同的联合方式保脾治疗的疗效。结果 136例患者中,27例采用非手术治疗,23例采用血管缝线缝合+生物蛋白胶粘合治疗,26例采用脾动脉结扎+局部缝合修补+生物蛋白胶粘合治疗,20例采用超声刀行部分脾脏切除+创面喷生物蛋白胶,17例采用脾动脉结扎+射频止血切割器行脾脏部分切除,23例采用腹腔镜下超声刀行部分脾脏切除+创面喷生物蛋白胶均全部治愈。保脾成功131例(95.58%),失败5例(4.42%)。无死亡患者。结论在脾损伤的治疗中,不同的保脾方法治疗成功率接近。保脾治疗的并发症发生率较低。应根据患者全身情况、脾脏破裂程度和分级、医疗设备和技术条件进行个体化治疗,对于有条件的医疗单位可以开展联合几种方式的保脾治疗。Objective To summarize the treatment effects and success rate of spleen-preserving treatments for patients with splenic injury, and to explore the ideal spleen-preserving treatment for different types of splenic injury. Methods We retrospectively analyzed the clinical data of 136 patients with splenic injury who underwent spleen-preserving treatment in the Department of Hepatobiliary Surgery between July 1998 and December 2010. And the treatment effects of different combined treatment methods were compared and studied. Results Twenty-seven patients were treated without surgery; 23 underwent vascular suture combined with fibrin glue treatment; 26 accepted splenic artery ligation, partial suture and fibrin glue treatment; 20 underwent ultrasonic scalpel partial splenectomy and wound spray fibrin glue treatment; 17 accepted splenic artery ligation and RF hemostatic cutter row spleen resection; and 23 accepted laparoscopic ultrasonic scalpel with partial splenectomy and wound spray fibrin glue treatment. Spleen-preserving succeeded in 131 cases （95.58%） and failed in 5 cases （4.42%） without any deaths. Conclusions In the treatment of splenic injury, the success rate of different methods of spleen-preserving is close. The success rate of combined use of several spleen-preserving methods together is higher. Under the principle of ＂Save lives first, and preserve spleen second＂, we should carry out individualized treatment plan for the patients based on patients＇ general condition, the extent and grade of splenic rupture, and medical equipment and technical conditions. For those medical units with good treatment conditions, combined spleen-preserving treatment can be performed.

关 键 词：脾破裂 保脾治疗 联合治疗 保脾术 非手术治疗 

分 类 号：R657.6[医药卫生—外科学]