天津医药

天津医药 ›› 2019, Vol. 47 ›› Issue (9): 962-965.doi: 10.11958/20191083

• 临床研究 • 上一篇    下一篇

自发性脾破裂13例诊治分析

王斌，朱新国△，蒋林华，姚一舟   

  1. 苏州大学附属第一医院普外科（邮编215006）
  • 收稿日期:2019-04-10 修回日期:2019-07-02 出版日期:2019-09-15 发布日期:2019-09-18
  • 通讯作者: 王斌 E-mail:wangbin81594@suda.edu.cn

Diagnosis and treatment of spontaneous splenic rupture in 13 cases

WANG Bin, ZHU Xin-guo△, JIANG Lin-hua, YAO Yi-zhou   

  1. Department of General Surgery, the First Affiliated Hospital of Soochow University, Soochow 215006, China △Corresponding Author E-mail: zxg45@hotmail.com
  • Received:2019-04-10 Revised:2019-07-02 Published:2019-09-15 Online:2019-09-18
  • Contact: Bin WANG E-mail:wangbin81594@suda.edu.cn

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摘要： 目的 探讨自发性脾破裂的临床表现、诊断方法及治疗策略。方法 收集2007年1月—2018年12月苏州 大学附属第一医院普外科收治的脾破裂患者，从中筛选出自发性脾破裂病例，对其发病原因、临床表现、辅助检查、 治疗情况、术后病理等资料进行回顾性分析。结果 期间收治脾破裂患者共 187 例，其中自发性脾破裂者 13 例 （6.95%），临床表现多以突发左上腹痛为主，一般无明显诱因，实验室检验均有不同程度低血红蛋白表现，B超或CT 诊断脾破裂伴腹腔积血，1例保守治疗无效后行脾切除术，1例行急诊数字减影血管造影（DSA）栓塞止血后限期行腹 腔镜脾切除术，余11例均行急诊脾切除术，术后常规病理诊断恶性肿瘤6例，血栓性脾肿大1例，淤血性脾肿大3例， 特发性3例。12例患者顺利出院，1例患者因术后二次出血自动出院后死亡。结论 自发性脾破裂临床表现隐匿， 病情凶险，需积极手术治疗，病理性脾脏是发生自发性脾破裂的常见原因，宜行脾脏切除术。

关键词: 脾破裂, 破裂, 自发性, 脾切除术, 诊治, 病理性脾脏

Abstract: Objective To investigate the clinical manifestation, diagnosis and treatment of spontaneous splenic rupture. Methods Patients with splenic rupture treated by the department of general surgery of the First Affiliated Hospital of Soochow University from January 2007 to December 2018 were collected. Data of patients with spontaneous splenic rupture were analyzed including the etiology, clinical manifestations, auxiliary examination, treatment and postoperative pathology retrospectively. Results A total of 187 cases of splenic rupture were treated during this period, among them 13 cases (6.95%) were spontaneous splenic rupture. The main clinical manifestations were sudden left upper abdominal pain without obvious inducement. All the laboratory tests showed different degrees of low hemoglobin. Splenic rupture with hemoperitoneum was diagnosed by B ultrasound or CT examination. After conservative treatment failed, 1 patient underwent splenectomy, 1 patient underwent laparoscopic splenectomy after emergency DSA embolization for hemostasis, and all the other 11 patients underwent emergency splenectomy. There were 6 cases of malignant tumor, 1 case of thrombotic splenomegaly, 3 cases of congestive splenomegaly and 3 cases of idiopathic splenic rupture. Twelve patients were discharged successfully, and one patient died after automatic discharge due to the postoperative hemorrhage. Conclusion Spontaneous splenic rupture has insidious clinical manifestations and dangerous conditions, requiring active surgical treatment. Pathological spleen is a common cause of spontaneous splenic rupture, and splenectomy is recommended.

Key words: splenic rupture, rupture, spontaneous, splenectomy, diagnosis and treatment, pathological spleen