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.
ObjectiveTo investigate the safety and feasibility of the treatment of laparoscopic splenectomy for patients with traumatic splenic rupture. MethodsBetween October 2006 and October 2009, 48 cases of traumatic splenic rupture underwent laparoscopic splenectomy were analyzed in this hospital. According to the differrent styles of splenic stalk, different operative methods were taken， including titanic clipping in 12 cases， titanic clipping combining silk suture ligation in 8 cases， snare combining titanic clipping in 10 cases， LigaSure in 8 cases， and EndoGIA in 8 cases. ResultsLaparoscopic splenectomy was successfully completed in 32 cases; Handassisted laparoscopic splenectomy was applied in 14 cases, and 2 cases were converted to laparotomy because of tight spleen adhesion with surrounding tissues and bleeding rupture of the short gastric vessels. The operation time was 120－170 min with an average 140 min; the estimated intraoperative amount of blood loss was 300－1 200 ml with an average 800 ml. No postoperative complication occurred such as gastric fistula, pancreatic fistula or hemorrhage. Conclusion According to the differrent styles of splenic stalk, individual operative method can improve mission success rate in the laparoscopic splenectomy in traumatic splenic rupture.
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 探討外傷閉合性脾破裂行脾保留手術的術式及療效。方法 回顧性分析我院2001年6月至2012年5月期間對外傷閉合性脾破裂行脾保留手術的32例患者的臨床資料。結果 32例外傷閉合性脾破裂患者中行單純黏合劑止血6例（Ⅰ級），單純縫合修補6例（Ⅰ級），縫合修補加黏合劑止血13例（Ⅰ/Ⅱ級），脾部分切除手術4例（Ⅱ/Ⅲ級），脾動脈結扎加脾修補術3例（Ⅱ/Ⅲ級）。32例行脾保留手術患者中除1例因手術后再出血行脾切除獲治愈外，其余31例均獲保脾成功，術后3～6個月行B超和CT檢查示脾臟生長良好，IgM、C3、C4等免疫功能指標均在正常范圍。結論 對Ⅰ～Ⅲ級外傷閉合性脾破裂行脾保留手術安全、可行，療效好，對保留和恢復脾臟功能有重要意義。
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 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。
目的 探討脾切除術后再出血的原因及診治方法并總結其預防措施。方法 對我院1998年8月至2009年3月收治的11例脾切除術后再出血患者的臨床資料進行回顧性分析。結果 本組11例再出血患者均行急診再手術治療，10例治愈,無術后并發癥，恢復順利，切口愈合良好，均拆線出院，術后住院10～21 d（平均15 d）； 余1例外傷性脾破裂者術中探查為胃短動脈破裂出血，遂結扎胃短動脈，術后發生胃瘺，經禁食、靜脈營養等治療，效果差，于術后20 d死亡。結論 脾切除術后再出血原因較多，以胃短血管處理不當、脾蒂血管結扎線脫落、胰尾部血管損傷及患者凝血功能障礙為主。脾切除術后出血以預防為主，術前充分做好各項準備，術中止血徹底，術后特別是術后24 h內嚴密觀察腹腔引流液的量、性質及速度。再出血后果嚴重，一旦發生，應及時準確診斷，行急診再手術治療。
ObjectiveTo summarize the treatment effects and success rate of spleen-preserving treatments for patients with splenic injury, and to explore the ideal spleen-preserving treatment for different types of splenic injury. MethodWe retrospectively analyzed the clinical data of 136 patients with splenic injury who underwent spleen-preserving treatment in the Department of Hepatobiliary Surgery between July 1998 and December 2010. And the treatment effects of different combined treatment methods were compared and studied. ResultsTwenty-seven patients were treated without surgery; 23 underwent vascular suture combined with fibrin glue treatment; 26 accepted splenic artery ligation, partial suture and fibrin glue treatment; 20 underwent ultrasonic scalpel partial splenectomy and wound spray fibrin glue treatment; 17 accepted splenic artery ligation and RF hemostatic cutter row spleen resection; and 23 accepted laparoscopic ultrasonic scalpel with partial splenectomy and wound spray fibrin glue treatment. Spleen-preserving succeeded in 131 cases (95.58%) and failed in 5 cases (4.42%) without any deaths. ConclusionsIn the treatment of splenic injury, the success rate of different methods of spleen-preserving is close. The success rate of combined use of several spleen-preserving methods together is higher. Under the principle of "Save lives first, and preserve spleen second", we should carry out individualized treatment plan for the patients based on patients' general condition, the extent and grade of splenic rupture, and medical equipment and technical conditions. For those medical units with good treatment conditions, combined spleen-preserving treatment can be performed.