【摘要】 目的回顾性总结14例迟发型脾破裂(DRS)的诊断、治疗经验。方法 14例经确诊为迟发性脾破裂患者,行脾切除术,术后置脾窝胶管引流。结果 14例手术成功,术后病理检查,证实为脾破裂,患者痊愈。结论 DRS是脾损伤后48 h才出现腹腔内出血症像的脾破裂。症状隐匿,早期诊断困难,易被漏诊、误诊,DRS发病凶险,处理不当并会危及生命,这就要求对本病要有高度的警惕性。辅助检查是本病诊断的重要手段。CT辅以反复的诊断性腹腔穿刺、诊断性腹腔灌洗及B超是有效的检查手断。治疗应本着"保命第一,保脾第二"的原则,一旦诊断明确,及时行脾切除术,其治疗快捷、可靠、有效。对Ⅲ级以下的脾破裂可选择性行保脾手术,包括脾修补术、脾部分切除术、选择性脾动脉栓塞术以及微波凝固治疗等。尽管目前有保脾的趋势,但保脾手术较为复杂,对于基层医院,不宜作为常规的手术方式。非手术治疗适合血液动力学稳定和无其他剖腹指征的患者。更多还原

【Abstract】 Objective To review and summarize the experiences in the diagnosis and treatment of 14 cases of delayed splenic rupture(DSR).Methods Fourteen cases with delayed splenic rupture underwent the splenectomy,and a catheter was placed in the splenic fossa to drain fluid after surgery.Results All 14 cases of operation were successful and the splenic ruptures were confirmed by postoperative pathologic examination.All patients recovered.Conclusion The delayed splenic rupture is the splenic rupture with a sign of intraperitoneal hemorrhage 48 hours after splenic injury.This disease,with insidious onset,is difficult to diagnose early and easy to be missed or misdiagnosed.DRS are potentially dangerous and life-threatening.CT scans combined with repetitive abdominal puncture and peritoneal lavage for a diagnostic test,B type ultrasonography were effective steps for the diagnosis of DSR.The splenectomy should be performed timely for the confirmed cases.The spleen neoplasty,partial splenectomy,partial splenic embolization and microwave coagulation therapy can be selected for the grade 1 to 3 splenic rupture.The spleen-conserving operation is too complex for the primary hospitals to carry out,though there is a trend in the treatment of splenic injuries.Non-surgical treatments are available for the patients with stable hemodynamic indexes and without other indication of abdominal section.更多还原