脾动脉栓塞治疗外伤性脾破裂的研究  

Study of Embolic Teatment of Traumatic Rupture of Spleen through Splenic Artery

作　　者：孙智勇[1] 

机构地区：[1]山东省菏泽市立医院普外科,274031

出　　处：《齐齐哈尔医学院学报》2003年第3期248-249,共2页Journal of Qiqihar Medical University

摘　　要：目的　研究脾动脉抑肽酶灌注、明胶海绵栓塞对外伤性脾破裂的止血效果及灌注栓塞后患者免疫功能的变化。方法　采用Seldinger技术 ,先进行脾动脉造影以明确诊断并进行Gall分级 ,然后用抑肽酶 5 0万u行脾动脉灌注及明胶海绵栓塞脾动脉主干或出血区脾动脉分支。术后 1个月、3个月、6个月、12个月分别测定患者淋巴细胞计数、C3 、C4、IgG、IgM、T淋巴细胞亚群CD3 、CD4、CD8。结果　 4 8例脾破裂患者 4 7例止血效果确切 ,保脾成功。 1例因脾动脉扭曲插管失败而行开腹手术治疗。 4 7例患者术后 1个月、3个月、6个月、12个月测定淋巴细胞计数、C3 、C4、IgG、IgM、CD3 、CD4、CD8,结果与正常人相比无差异 (P值均 >0 .0 5 )。结论　用抑肽酶行脾动脉灌注、明胶海绵栓塞是治疗脾破裂Gall分级Ⅰ～Ⅲ级可靠而有效的方法 。Objective To study the hemostatic effect of trasylol perfusion through splenic artery and gelatin sponge embolism on rupture of spleen and the changes of the patient's immunologic function after perfusion embolism. Methods With seldinger technique,the splenic arteriography was performed,the definite diagnosis was made and Gall grading was carried out.And then the perfusion through splenic artery was carried out with 500,000 unit of trasylol and the embolism of the trunk of splenic artery and the branch of splenic artery in bleeding part was also carried out with gelation sponge.The patients' lymphocytic count,such as,C 3,C 4,IgG,IgM,T lymphocyte subpopulation CD 3,CD 4,andCD 8 were determined respectively in 1 month,3 months,6 months and12 months.Results The hemostatic effect was definite in 47 of 48 cases of rupture of spleen.The spleen was successfully preserved. Laparotomy was performed because of failure of bending cannula through splenic artery in one case. 47 patients lymphocytic count, C 3,C 4,IgG,IgM,CD 3,CD 4,CD 8 were determined in 1 month, 3 months,6 months and 12 months, and the results were not different from those of normal human(P>0.05). Conclusions It is a reliable and effective way to treat I～Ⅲ grade of Gall grading of rupture of spleen with trasylol perfusion through splenic artery and with gelation sponge embolism.The patients' immunologic functions are normal after operation.

关 键 词：脾动脉栓塞治疗 外伤性脾破裂 抑肽酶 明胶海绵 止血 免疫功能 

分 类 号：R657.62[医药卫生—外科学]