CAJ | 학술논문

目的探讨泌尿外科手术中脾损伤的原因及防治方法. 方法回顾性分析1990-2011年我院496例泌尿外科手术中16例脾损伤的临床资料.其中左肾癌根治术9例,左肾错构瘤剜除术3例,左肾上腺肿瘤切除术4例.损伤位于脾外缘8例,脾肾韧带附近6例,脾门附近2例.16例中行保脾手术14例(Ⅰ级损伤8例,Ⅱ级6例).其中3例直接采用止血纱布压迫止血；5例采用电凝、黏合、止血纱布压迫止血；2例Ⅱ级损伤者用可吸收线作兜底U形缝合,涂生物蛋白胶后再用止血纱布压迫止血；2例Ⅱ级损伤者缝合时将部分大网膜缝入,喷涂生物胶后用明胶海绵压迫；2例Ⅱ级损伤者行脾动脉分支结扎术.2例(Ⅱ级、Ⅲ级各1例)行脾切除术. 结果 14例保留脾脏和2例脾切除患者均治愈出院.随访6个月～5年,无脾脏延迟出血及脾功能异常.1例患者术后6个月死于癌复发转移. 结论泌尿外科左肾及左肾上腺巨大肿瘤手术时,脾损伤是一种较常见的并发症.重在预防,一旦发生术中脾损伤,应根据具体伤情选择合理术式,尽可能保留脾脏.
목적 탐토비뇨외과수술중비손상적원인급방치방법. 방법 회고성분석1990-2011년아원496례비뇨외과수술중16례비손상적림상자료.기중좌신암근치술9례,좌신착구류완제술3례,좌신상선종류절제술4례.손상위우비외연8례,비신인대부근6례,비문부근2례.16례중행보비수술14례(Ⅰ급손상8례,Ⅱ급6례).기중3례직접채용지혈사포압박지혈；5례채용전응、점합、지혈사포압박지혈；2례Ⅱ급손상자용가흡수선작두저U형봉합,도생물단백효후재용지혈사포압박지혈；2례Ⅱ급손상자봉합시장부분대망막봉입,분도생물효후용명효해면압박；2례Ⅱ급손상자행비동맥분지결찰술.2례(Ⅱ급、Ⅲ급각1례)행비절제술. 결과 14례보류비장화2례비절제환자균치유출원.수방6개월～5년,무비장연지출혈급비공능이상.1례환자술후6개월사우암복발전이. 결론 비뇨외과좌신급좌신상선거대종류수술시,비손상시일충교상견적병발증.중재예방,일단발생술중비손상,응근거구체상정선택합리술식,진가능보류비장.
Objective To discuss the cause,treatment and prevention of splenic injury during the urological surgery.Methods The clinical data of 16 cases with splenic injury in operation for renal and adrenal tumors in 496 cases were retrospectively analyzed.Nine cases were left radical nephrectomy,3 cases were left renal hamartoma enucleation,4 cases were left adrenal tumor resection.Damage located at outer edge of the spleen in 8 cases,the splenorenal ligament in 6 cases,and the splenic hilum in 2 cases.In these 16 cases,14 patients spared the spleen (Ⅰ Grade injury 8 cases,Ⅱ grade 6 cases).The injuryed spleen was directly pressed with hemostatic gauze in 3 cases; 5 patients used coagulation,bonding,hemostatic gauze to stop bleeding; 2 cases of grade Ⅱ injury used U-shaped suture and coated with fibrin glue,then compressed with hemostatic gauze to stop bleeding; 2 cases of grade Ⅱ injuries with the greater omentum stitched into the seam,sprayed biological glue,were compressed with gelatin sponge; 2 cases of grade Ⅱ injury underwent splenic artery branch ligation.The other 2 cases (1 Ⅱ grade and 1 Ⅲ grade) underwent splenectomy.Results All of the 16 patients were cured and followed up for 6 months to 5 years.There was no delayed bleeding of spleen and splenic dysfunction.One patient died of tumor recurrence 6 months after operation.Conclusions Splenic injury is a common complication during urological surgery,especially the tumor is large or adhered to spleen in the upper pole of left kidney.Once spenic injury occurs,doctors should choose the right treatment plan according to surgical injury,and try to save the spleen.