外伤性脾破裂伤86例诊治探讨-第三军医大学学报.docVIP

外伤性脾破裂伤86例诊治探讨 刘芸1 ,张海生2 (1.浙江省宁波市镇海区骆驼医院, 浙江宁波 315202；2.宁波大学医学院附属医院, 浙江宁波 315020) 【摘要】 目的:探讨外伤性脾破裂伤急症诊断、治疗决策、手术方法。抢救生命同时保留脾脏，以尽力维持人体的免疫功能。方法:回顾性分析1998年1月至2007年12月经我院抢救的脾破裂伤病人86例的临床资料。 结果:外伤性 81例（占94.1％），其中急性78例，延迟性脾破裂3例,医源性损伤5例（占5.8%）；闭合性伤71例（71/81,占87.7％），开放伤10例（占12.3％）；合并其他脏器损伤31例（占38.3％）；非手术治疗8例（9.3％），手术治疗78例（90.7％）。破裂级别：Ⅰ级10例，Ⅱ级46例，Ⅲ级19例，Ⅳ级11例。手术方式：脾切除术63例（80.8％），脾部分切除及修补术15例（19.2％）。手术后并发症12例。均获痊愈，无死亡。结论:急性外伤性脾破裂病人抢救关键在于快速、准确判断伤情，及时选择合理的治疗方式，能获得较高的抢救成功率，也能争取保留脾脏功能。 【关键词】 外伤性脾破裂；急诊诊断；治疗决策；保脾 Clinical investigation on the diagnosis and treatment of 86 cases with traumatic rupture of spleen Liu Yun and Zhang Hai-sheng ( Department of Surgery, the Zhenhai Luotuo Hospital, and Department of Surgery, the Affiliated Hospital of Medical School Ningbo University, Ningbo, Zhejiang, P. R. China ) Abstract : Objective To investigate the emergent diagnosis, treatment strategy and the choice of the type of surgical operation on the patients with traumatic rupture of spleen. The purpose is for saving life, trying best to preserve spleen and to maintain the immune function of the patients. Methods Clinical data on 86 patients with spleen rupture, admitted to hospital emergently between Jan 1998 and Dec 2007, were analyzed retrospectively. Results There were 81 cases with traumatic rupture of spleen (94.1%), including 78 cases with acute traumatic rupture and 3 with delayed rupture of spleen, whereas another 5 cases with spleen rupture caused by iatrogenic injuries (5.8%). There were 71 cases with closed abdominal injury (87.7%) and 10 with open injury (12.3%), 31 cases complicated with other organ injuries (38.3%). Of all patients, 8 cases were given non-operative treatment (9.3%) and 78 cases given surgical operation treatment (90.7%). Spleen-rupture scales: 10 cases for grade I, 46 for grade II , 19 for grade III , and 11 for grade IV. Type of surgical operation for the patients: 63 cases with splenectomy (80.8%), 15 cases with restorative operation and partial resecti