关键词: 脾破裂, 损伤, 治疗

Abstract: Objective To investigate the therapeutic methods of preserving spleens for splenic injuries.Methods The diagnosis and treatment of 46 patients with splenic trauma from 1995 to 2003 were reviewed retrospectively.Results All patients were divided into four groups, nonoperative group, operative repairing group, spleen resection plus autotransplantation group and vascular intervention group(splenic artery embolism).Twenty-three patients in the nonoperative group according to trauma grade were classified as grade Ⅰ in 8 cases, grade Ⅱ in 10 patients, grade Ⅲ in 1 patient and unknown grade in the rest 4 cases respectively.Three cases had traumatic shock.Nonoperative therpy accounts for 20% in the treatment of all splenic trauma.In the repairing group, nine cases were classified as grade Ⅱ in 1 case, grade Ⅲ in 7 cases and grade Ⅳ in 1 case, and 7 cases had shock in the group.Total spleen excision and autotransplantation were performed for 8 cases with grade Ⅲ in 1 case and grade Ⅳ in₇ cases, and 5 patients had shock.Six patients classified as grade Ⅱ and Ⅲ included 2 cases and 4 cases respectively in the splenic artery embolize group, and all patients without shock were treated successfully with one time embolization.All 46 patients had no complications, and 45 cases were recovered except one being in vegetative status caused by craniocerebral injury.There were no significant difference in hospitalization in the four groups.Conclusion Splenic injuries of grade Ⅰ and Ⅱ may be given priority to nonoperative therapy, and grade Ⅲ is fit for splenic artery embolism or repairing for preserving spleen.Splenic trauma of grade Ⅳ or above should only be operated for preserving spleen.And therapeutic methods should be selected according to individual's condition and combined agilely.

Key words: splenic rupture, trauma, treatment