目的 总结外伤性延迟性脾破裂的诊断与治疗经验.方法 回顾性分析2005年1月至2013年12月上海市大场医院收治的26例外伤性延迟性脾破裂患者的临床资料,分析患者的病史、临床表现、实验室及辅助检查结果,对患者进行国内脾损伤4级法分级.根据患者病情、脾损伤程度及受伤时间等,选择合适手术方式.采用门诊及电话方式进行随访,随访时间截至2014年6月.结果 26例患者均为左季肋区有明确受伤史,受伤后有轻微腹痛,然后疼痛缓解,活动或增加腹腔压力,48 h后出现明显全腹痛;均有面色苍白,全腹压痛,反跳痛及肌紧张,脉搏＞100次/rain患者20例,血压＜90/60 mmHg(l mmHg=0.133 kPa)患者15例.Hb＜5g/L 3例,5～ 10 g/L 21例.行腹腔穿刺术26例,抽出不凝血25例.行B超检查26例,发现脾破裂24例.行CT检查19例,均发现脾破裂.Ⅰ级10例,Ⅱ级12例,Ⅲ级3例,Ⅳ级1例.26例患者均行手术治疗,其中行单纯脾缝合修补术2例,脾下极切除术2例,单纯脾全切除术9例,脾全切除术联合自体脾组织大网膜内移植术13例.2例因失血性休克于围手术期死亡,其余24例治愈出院.手术时间为(90±15) min,术中腹腔内积血量为(1 500±700)mL,输血例数为24例,平均输血量为1 200 mL.术后平均住院时间为16.7 d.术后2例患者发生并发症,分别为左侧胸腔积液和脾窝积液,经对症处理后治愈.全组患者无感染及其他并发症发生.治愈的24例患者均获得随访,随访时间为6～108个月,中位随访时间为46个月.l例因大面积心肌梗死于术后5年死亡,其余23例患者均健康生存.结论 B超和CT检查是诊断外伤性延迟性脾破裂最重要的手段.患者有左季肋区外伤史,有腹痛、腹痛缓解、再突然腹痛病程,缓解期＞48 h,有腹腔内出血的相应症状和体征,B超和CT检查结果示脾破裂征象时应考虑外伤性延迟性脾破裂.对外伤性延迟性脾破裂患者的治疗,应严格把握保留脾脏或脾切除手术适应证,及时积极地行合理有效的手术治疗.
目的 總結外傷性延遲性脾破裂的診斷與治療經驗.方法 迴顧性分析2005年1月至2013年12月上海市大場醫院收治的26例外傷性延遲性脾破裂患者的臨床資料,分析患者的病史、臨床錶現、實驗室及輔助檢查結果,對患者進行國內脾損傷4級法分級.根據患者病情、脾損傷程度及受傷時間等,選擇閤適手術方式.採用門診及電話方式進行隨訪,隨訪時間截至2014年6月.結果 26例患者均為左季肋區有明確受傷史,受傷後有輕微腹痛,然後疼痛緩解,活動或增加腹腔壓力,48 h後齣現明顯全腹痛;均有麵色蒼白,全腹壓痛,反跳痛及肌緊張,脈搏＞100次/rain患者20例,血壓＜90/60 mmHg(l mmHg=0.133 kPa)患者15例.Hb＜5g/L 3例,5～ 10 g/L 21例.行腹腔穿刺術26例,抽齣不凝血25例.行B超檢查26例,髮現脾破裂24例.行CT檢查19例,均髮現脾破裂.Ⅰ級10例,Ⅱ級12例,Ⅲ級3例,Ⅳ級1例.26例患者均行手術治療,其中行單純脾縫閤脩補術2例,脾下極切除術2例,單純脾全切除術9例,脾全切除術聯閤自體脾組織大網膜內移植術13例.2例因失血性休剋于圍手術期死亡,其餘24例治愈齣院.手術時間為(90±15) min,術中腹腔內積血量為(1 500±700)mL,輸血例數為24例,平均輸血量為1 200 mL.術後平均住院時間為16.7 d.術後2例患者髮生併髮癥,分彆為左側胸腔積液和脾窩積液,經對癥處理後治愈.全組患者無感染及其他併髮癥髮生.治愈的24例患者均穫得隨訪,隨訪時間為6～108箇月,中位隨訪時間為46箇月.l例因大麵積心肌梗死于術後5年死亡,其餘23例患者均健康生存.結論 B超和CT檢查是診斷外傷性延遲性脾破裂最重要的手段.患者有左季肋區外傷史,有腹痛、腹痛緩解、再突然腹痛病程,緩解期＞48 h,有腹腔內齣血的相應癥狀和體徵,B超和CT檢查結果示脾破裂徵象時應攷慮外傷性延遲性脾破裂.對外傷性延遲性脾破裂患者的治療,應嚴格把握保留脾髒或脾切除手術適應證,及時積極地行閤理有效的手術治療.
목적 총결외상성연지성비파렬적진단여치료경험.방법 회고성분석2005년1월지2013년12월상해시대장의원수치적26예외상성연지성비파렬환자적림상자료,분석환자적병사、림상표현、실험실급보조검사결과,대환자진행국내비손상4급법분급.근거환자병정、비손상정도급수상시간등,선택합괄수술방식.채용문진급전화방식진행수방,수방시간절지2014년6월.결과 26례환자균위좌계륵구유명학수상사,수상후유경미복통,연후동통완해,활동혹증가복강압력,48 h후출현명현전복통;균유면색창백,전복압통,반도통급기긴장,맥박＞100차/rain환자20례,혈압＜90/60 mmHg(l mmHg=0.133 kPa)환자15례.Hb＜5g/L 3례,5～ 10 g/L 21례.행복강천자술26례,추출불응혈25례.행B초검사26례,발현비파렬24례.행CT검사19례,균발현비파렬.Ⅰ급10례,Ⅱ급12례,Ⅲ급3례,Ⅳ급1례.26례환자균행수술치료,기중행단순비봉합수보술2례,비하겁절제술2례,단순비전절제술9례,비전절제술연합자체비조직대망막내이식술13례.2례인실혈성휴극우위수술기사망,기여24례치유출원.수술시간위(90±15) min,술중복강내적혈량위(1 500±700)mL,수혈례수위24례,평균수혈량위1 200 mL.술후평균주원시간위16.7 d.술후2례환자발생병발증,분별위좌측흉강적액화비와적액,경대증처리후치유.전조환자무감염급기타병발증발생.치유적24례환자균획득수방,수방시간위6～108개월,중위수방시간위46개월.l례인대면적심기경사우술후5년사망,기여23례환자균건강생존.결론 B초화CT검사시진단외상성연지성비파렬최중요적수단.환자유좌계륵구외상사,유복통、복통완해、재돌연복통병정,완해기＞48 h,유복강내출혈적상응증상화체정,B초화CT검사결과시비파렬정상시응고필외상성연지성비파렬.대외상성연지성비파렬환자적치료,응엄격파악보류비장혹비절제수술괄응증,급시적겁지행합리유효적수술치료.
Objective To summarize the experiences in the diagnosis and treatment of delayed rupture of spleen.Methods The clinical data of 26 patients with traumatic delayed rupture of spleen who were admitted to the Dachang Hospital from January 2005 to December 2013 were analyzed retrospectively.The medical history,clinical presentation,results of laboratory examinations were analyzed,and the splenic trauma was graded.Surgical procedures were selected according to the condition,severity of the splenic trauma and time of injury.Patients were followed up via outpatient examination or telephone interview till June 2014.Results Twenty-six patients had the history of injury of the left hypochodriac region,and were accompanied by slight abdominal pain and a short period of pain alleviation,and then pain in all regions of the abdomen at postoperative hour 48.All thepatients had pale face,tenderness,rebound tenderness or tonus.The pulse above 100 per minute was observed in 20 patients,and 15 patients had blood pressure under 90/60 mmHg (1 mmHg =0.133 kPa).The level of hemoglobin under 5 g/L was observed in 3 patients,and 5-10 g/L in 21 patients.All the 26 patients received abdominal paracantesis,non-coagulating blood was extracted in 25 patients.Twenty-six patients received B ultrasonography,and 24 had splenic rupture.Nineteen patients received computed tomography (CT),and 19 had splenic rupture.Ten patients had type Ⅰ splenic rupture,12 had type Ⅱ splenic rupture,3 had type Ⅲ splenic rupture and 1 had type Ⅳ splenic rupture.All the 26 patients received operation,including 2 received suture of the ruptured spleen,2 received resection of the lower part of the spleen,9 received total splenic resection,and 13 received total splenic resection + autogeneous transplantation of greater omentum.Two patients died of hemorrhagic shock intraoperatively,and the other 24 patients were cured.The operation time and volume of hemoperitoneum were (90 ± 15)minutes and (1 500 ± 700) mL,respectively.Twenty-four patients received blood transfusion,with the volume of transfused blood of 1 200 mL.The mean duration of hospital stay was 16.7 days.Two patients had complications after the operation,which were left pleural effusion and splenic fossa effusion,and they were cured by symptomatic treatment.No infection or other complications were observed.All the 24 patients were followed up for 6-108 months (median,46 months).One patient died of myocardial infarction at postoperative year 5,and the other 23 patients survived.Conclusions B sonography and computed tomography are important methods for the treatment of delayed rupture of spleen.Traumatic delayed rupture of spleen should be considered when the patient had symptoms including history of injury of the left hypochondriac region,the course of abdominal pain,abdominal pain alleviation,abdominal pain recurrence,time for abdominal pain alleviation longer than 48 hours,interperitoneal hemorrhage and the signs of splenic rupture indicated by B ultrasonography and computed tomography.The indication of spleen-preservation surgery or splenectomy for patients with delayed rupture of spleen should be strictly controlled and optimal surgical procedure should be designed according to the condition of the patient.
