部分脾动脉栓塞治疗外伤性脾破裂  

A clinical study on the treatment of traumatic rupture of spleen by partial splenic embolization

作　　者：赵涛[1] 吕维富[2] 刘永庆[1] 张学彬[2] 吕德超[1] 曹荣格[1] 王高生[1] 解光艾[1] 何玉圣[2] 赵锡军[2] 

机构地区：[1]安徽省立医院急诊外科,合肥230001 [2]安徽省立医院放射科,合肥230001

出　　处：《安徽医科大学学报》2003年第4期292-294,共3页Acta Universitatis Medicinalis Anhui

摘　　要：目的　探讨部分脾动脉栓塞 (PSE)治疗外伤性脾破裂的止血效果及术后脾功能状况。方法　采用Seldinger技术 ,经股动脉插入 5～ 6FCobra导管或RS导管至脾动脉 ,行脾脏术中数字减影血管照影 (DSA) ,显示破裂区域的出血动脉 ,然后超选择性插管至该动脉 ,经导管注入相应大小和数量的明胶海绵颗粒 ,栓塞出血动脉。常规于右下腹麦氏点 ,经皮穿刺置入 8F“猪尾巴”多孔引流管 ,引流腹腔积血。确认无污染、溶血者 ,行自体血回输。于术后 0 5～ 18个月行Bus、CT及99mTc检查 ,监测脾脏形态、密度、血流灌注情况 ,测定血小板及血中IgM、IgG、C3 、C4水平。结果　全组共 30例外伤性脾破裂 (AASTⅤ级以下 ) ,止血效果确切 ,脾脏全部存活 ,免疫指标正常。结论　部分脾动脉栓塞 (PSE)治疗外伤性脾破裂安全、微创、无严重并发症 。Objective To study the hemostasis efficacy and spleen function conditions after the treatment of traumatic rupture of spleen by partial splenic embolization(PSE). Methods 5～6F Cobra catheter or RS catheter was inserted into spleen artery by Seldinger’s technique; performs spleen DAS was performed to display the hemorrhagic arteries of traumatic area. Then, catheter was inserted into the artery ultra selectively,and Gelfoam particles was infused. Finally, 8F pigtail catheter was implanted by peritoneocentesis at McBurney’s point to drain the blood. Non polluted and non laky blood was re infused to the same patient. Bus,CT and 99m Tc were taken about half month to eighteen months after the operation to detect the outline,density and blood perfusion of spleen. The number of platelet and the the level of IgM,IgG,C 3,C 4 in blood were tested. Results Among the total 30 cases(below AAST Ⅴ),the hemostasis efficacy was complete; the spleens were all alive; immunologic parameters were all normal. Conclusion Partial splenic embolization(PSE) is safe,with minor micro injuries and no complications in treatment of traumatic rupture of spleen,so it corresponds to the modern demands of reserving spleen and its function.

关 键 词：外伤性脾破裂 部分脾动脉栓塞 治疗 止血效果 术后 脾功能 

分 类 号：R657.62[医药卫生—外科学]