In order to preserve more normal tissue in situ in case of severe traumatic rupture of spleen, simultaneous ligation of splenic artery and vein was performed successfully on animals and then was applied for clinic use. The preserved splenic tissue all survivied and functioned well. Patients with severe traumatic rupture of spleen grade Ⅳ-Ⅴ were all cured by ligation of both the splenic artery and vein at the same time.
目的 總結應用脾動脈結扎加脾部分切除術治療外傷性脾破裂的臨床經驗。方法 對本院近8年間收治的64例接受脾動脈結扎加脾部分切除治療的脾外傷患者的臨床資料進行回顧性分析，重點分析脾部分切除術的手術方法、臨床療效和適應證。結果 術中雙重結扎脾動脈，然后根據脾臟損傷的情況決定保留脾臟的部位，保證殘脾不少于原脾體積的30%。全組無手術死亡病例，術后出現早期并發癥者16例（25.0%），其中發熱8例，脾窩積液1例，腸梗阻2例，左側胸腔積液3例，切口感染2例，均經對癥處理后治愈。結論 對部分外傷性脾破裂患者的治療選擇脾動脈結扎加脾部分切除術是安全可行的。
Objective To compare the difference of the changes of platelet counts after splenectomy between the patients with splenic rupture and patients with cirrhosis and portal hypertension, and to analyze the possible reasons and clinical significance. Methods The platelet count of 47 splenic rupture patients and 36 cirrhosis patients who had been carried out splenectomy from July 2008 to December 2009 in our hospital were counted, and the differences in platelet count and it’s change tendency of two groups were compared. Results In the splenic rupture group，the platelet count of all 47 patients increased abnormally after operation, the maxlmum value of platelet count among 300×109/L-600×109/L in 6 cases，600×109/L-900×109/L in 21 cases，and above 900×109/L in 20 cases. In the cirrhosis group，the maxlmum value of platelet count after operation was above 300×109/L in 26 cases，100×109/L-300×109/L in 8 cases，and below 100×109/L in 2 cases. The difference of maxlmum value of platelet count in the two groups had statistic significance（P=0.00）. Compared with the cirrhosis group, the platelet count increased more significant and decreased more slow in splenic rupture group（P＜0.05）.The abnormal days and rising range of platelet count were higher in patient with Child A than Child B and C（P=0.006，P=0.002）. Conclusions The change of platelet count after operation in splenic rupture group was obviously different from cirrhosis group because of the difference of the liver function and body situation of patients. To patients with splenic rupture or cirrhosis, appropriate treatment based on the platelet count and liver function could obtain good therapeutic effect.
From 1982 to 1991, there were 13 cases of traumatic rupture of spleen, 26 percent in a total of 50 cases of splenic rupturesin the same period. The abdominal punctures were all positive preoperatively. In general, traumatic rupture of spleen should bc first repaired, if it failed, the subsplenectomy or transplatation of autosplenic tissues in the omental sack might be adopted. We used the technique to repair the ruptured splenic tissues in order to achieve cure. They did not require a second operation. Immunoiogical evaluation was normal 3-4 week safter operation .No postoperative sepsis was encountered.The follow-up results were good (1-7years,mean 3.5years).
目的探討腹腔鏡技術在治療外傷性脾破裂中的可行性和安全性。 方法回顧性分析筆者所在醫院2012年3月至2014年3月期間應用腹腔鏡技術救治的19例外傷性脾破裂患者的臨床資料。 結果本組19例患者中，順利完成腹腔鏡手術17例，中轉開腹2例，均獲得成功救治，痊愈出院。其中行腹腔鏡下電凝止血＋生物蛋白膠黏合保脾4例，行腹腔鏡下無損傷線縫合＋網膜覆蓋保脾8例，行腹腔鏡脾切除術5例，中轉開腹行脾切除術2例。手術時間50～186 min，平均90 min；術中失血250～2 200 mL，平均780 mL；術后住院時間7～26 d，平均13.5 d，術后均無并發癥發生。術后19例患者均獲訪，隨訪時間為3～12個月，平均8個月。隨訪期間無死亡及遠期并發癥發生。 結論對外傷性脾破裂患者選擇性施行的腹腔鏡脾修補術和脾切除術具有良好的效果，其具有創傷小、痛苦輕及恢復快的優點，安全而可行，值得推廣。
ObjectiveTo analyze the platelet (PLT) count, coagulation function, and portal vein thrombosis (PVT) in the patients underwent splenectomy due to different etiologies. MethodsThe patients who underwent splenectomy in the Affiliated Hospital of Southwest Medical University from January 2013 to December 2022 were collected. According to the etiology, the patients were assigned into the occupying group (splenic and pancreatic occupying lesions), hypersplenism group (portal hypertension and hypersplenism), and splenic rupture group (traumatic splenic rupture). The changes of PLT, white blood cells (WBC), red blood cells (RBC), neutrophils (Neut), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib), D-dimer (DD), and PVT were observed after splenectomy. ResultsA total of 166 patients were collected, including 42 in the occupying group, 22 in the hypersplenism group, and 102 in the splenic rupture group. There were no statistically significant differences in the age and preoperative Child-Pugh score among the patients of the three groups (P>0.05). There were 12 (7.2%) patients with PVT, including 2 in the occupying group, 6 in the hypersplenismn group, and 4 in the splenic rupture group. The PVT incidence among the three groups had a statistical significant difference (Fisher exact test, P=0.003), which in the hypersplenismn group was higher than the occupying group (P=0.016) and the splenic rupture group (P=0.002), while there was no statistically significant difference between the occupying group and the splenic rupture group (P=1.000). The overall trend was that the PLT, RBC, WBC, and various coagulation function indicators such as PT, APTT, and Fib among the three groups all showed an upward trend immediately after splenectomy, but the postoperative peak time and change trends had no markedly regular among the three groups. The PLT of the patients with and without PVT changed over time during the observation period (patients without PVT: F=60.238, P<0.001; patients with PVT group: F=9.700, P=0.043), and which showed a continuous upward trend after surgery, reaching a peak on the 14th day and then beginning to decline in the patients of both 2 groups. However, there was no statistically significant intergroup effect between the 2 groups (F=0.056, P=0.816). ConclusionsThe results of this study suggest that the peak value of PLT in the hypersplenism group is lower as compared with the occupying group and the splenic rupture group, and the PVT is more likely to occur. However, no difference of the PLT level is found in the patients without and with PVT.