部分性脾栓塞术治疗外伤性脾破裂的疗效和经验  

An analysis of the clinical efficacy and experience on the management of traumatic splenic rupture by partial splenic embolization

作　　者：吕维富[1] 张学彬[1] 张行明[1] 赵涛[2] 何玉圣[1] 赵锡军[1] 荚伟萍[1] 厉月琴[1] 

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

出　　处：《中华放射学杂志》2003年第12期1092-1096,共5页Chinese Journal of Radiology

摘　　要：目的　分析经皮穿刺部分性脾栓塞术 (PSE)治疗外伤性脾破裂的止血效果和临床经验。方法　 34例经超声、CT和腹腔穿刺证实为闭合性外伤性脾破裂病人。采用Seldinger技术 ,将 5FCobra 2导管经右侧股动脉插至脾动脉 ,行DSA检查 ,对出血的部位、范围和严重程度等进行评估 ,然后超选择插管至出血动脉 ,经导管注入 2mm× 2mm× 2mm或 2mm× 2mm× 10mm大小的明胶海绵颗粒 (条 ) ,栓塞破损血管。于右下腹麦氏点处 ,经皮穿刺置入 8F“猪尾”多侧孔引流管 ,引流腹腔积血。确认无污染、无溶血者 ,行积血回输。于PSE后 7、14d对全部病例作血常规和脾脏超声检查。并在术后 7(7例 )、14 (7例 )、30 (7例 )、6 0 (7例 )和 90 (6例 )d行脾脏CT扫描。结果　本组病例全部止血成功 ,技术成功率和止血有效率均为 10 0 %。 17例行腹腔积血自体回输 ,平均回输血量 (6 6 0± 190 )ml(4 0 0～ 16 0 0ml)。PSE后 3～ 7d拔除引流管 ,平均住院日 (7± 2 .3)d(4～ 14d)。CT随访显示 :术后 7d脾脏体积增大 ,PSE区密度减低 ,与被栓塞动脉的供血范围一致 ,腹腔积液明显减少或消失。 14d显示梗死区密度进一步减低 ,与周围脾组织境界清楚。 30d脾体积缩小 ,外形不规则 ,呈波浪状。 6 0～90d ,脾外形进一步缩小 ,轮廓呈分叶状 。Objective To evaluate the hemostasia efficacy and clinical experience of interventional management of the patients with traumatic splenic rupture by partial splenic embolization (PSE). Methods Thirty-four patients with traumatic splenic rupture due to falls, traffic accidents, and assaults were included. A 5 F Cobra catheter was inserted into splenic artery by Seldinger′s technique. The splenic artery digital subtraction angiography (DSA) was performed to display the locus, dimension, and severity degree, and gelfoam particles were infused through the catheter. Finally, a 8 F‘pigtail’drainage catheter was implanted into the lower abdominal cavity at McBurney′s point by percutaneous puncture to drain the hemoperitoneum. If the blood was not polluted and had no hemolysis, the autoreinfusion was performed. Abdomen ultrasonography and blood routine examinations were taken in all patients in 7 and 14 days after PSE, and CT scanning of spleen was performed to detect the outline and density of the spleen in 7 (7 patients), 14 (7 patients), 30 (7 patients), 60 (7 patients), and 90 (6 patients) days, respectively. Results The hemostasis were successful in all of 34 patients by PSE. The autoreinfusion was performed in 17 patients. The average transfusion volume was (660±190) ml (400-1 600 ml). The drainage-tube was pulled out in 3-7 postoperative days. The average admission time was (7±2.3) days(4-14 days). According to the CT follow-up, splenic enlargement and embolic splenic infarction were found in 7 days after PSE. The density of the infarction areas was significantly lower in 14 days, which corresponded well with the embolized areas. The splenic size decreased in 30 days, and the absorption of the low-density areas was showed. The splenic outline form was irregular and foliate in 60-90 days. Conclusion PSE is a safe, micro-injuried, and effective means for the management of traumatic splenic rupture, so it can meet the demands of mordern medicine for preserving splenic function.

关 键 词：部分性脾栓塞术 外科治疗 外伤性脾破裂 临床经验 止血 

分 类 号：R657.62[医药卫生—外科学]