游走性脾脏并扭转的手术治疗  

Surgical Intervention Treatment for Patients with Torsion of the Wandering Spleen

作　　者：王春喜[1] 陈婧如 宋清彬[2] 王琦[3] 张勇[1] 牛磊[1] 

机构地区：[1]中国人民解放军总医院普通外科,北京100853 [2]中国医科大学第一医院普外三科,沈阳110001 [3]吉林大学第一医院血管外科,长春130001

出　　处：《中国现代手术学杂志》2015年第4期246-250,共5页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨游走性脾脏合并扭转的手术方法,总结游走性脾脏扭转的病理学特征和手术操作体会。方法回顾性总结1993年1月-2013年1月间收治的11例游走性脾脏患者的临床资料,收集其临床特征、影像学资料、具体手术步骤,以及难点处理策略。其中,腹腔内7例,盆腔4例。所有病例均在全身麻醉下行游走脾脏切除,术中均见脾蒂扭转。分离、钳夹、离断脾蒂4例,一次性直线切割闭合器离断脾蒂7例。结果本组手术过程均顺利,手术时间50-150 min,平均（81.82±32.33）min;出血量50-210 ml,平均（100.45±47.79）ml。术后恢复顺利,无发热、腹腔积液,无呼吸道和腹腔感染,切口愈合良好,术后7-9 d拆线,均于手术后10-14 d出院。1例血小板减少者术后2 d即恢复正常水平。术后随访2-15年,10例存活,1例术后2年死于肺动脉栓塞。结论外科切除脾脏是治疗游走脾脏并扭转的可靠方法,根据扭转脾蒂的特点选用安全适宜的离断方法是确保手术安全、顺利的关键。Objective To investigate the operative method in patients with the torsion of the wandering spleen,and to summarize the pathologic characteristics of wandering spleen and operating experience in such patients. Methods The clinic data of 11 patients with the torsion of the wandering spleen from January 1993 to January 2013 was summarized retrospectively including the clinic manifestations,the imaging data,operating procedure,and strategies of dealing with the complicated events. 7 cases were found abdominal wandering spleen and 4 cases were pelvic wandering spleen. All patients were received splenectomy under general anesthesia. Results The operative duration was 50 to 150 min with an average of（ 81. 82 ± 32. 33） min,and the blood loss was 50 to 210 ml with an average of（ 100. 45 ± 47. 79） ml. All 11 cases achieved smooth recovery without post-operative complications as fever,seroperitoneum and infection of respiratory and peritoneal cavity.The patients were followed up for 2 to 15 years. 10 patients were survival and 1 patient was died of pulmonary embolism 2 years after the operation. Conclusions The splenectomy is a reliable method to treat the patients with torsions of wandering spleen. It is very important to choose a reasonable splenic pedicel disconnection based on the torsion characteristics,which is a key to ensure the safety of operating procedure.

关 键 词：游走脾 脾切除术 

分 类 号：R657.64[医药卫生—外科学]