脾动脉栓塞术后出现严重粘连的脾切除手术体会

目的:探讨脾动脉栓塞术后严重脾粘连脾切除手术技巧,为临床实践提供可借鉴的方法。方法:收集我院2005年4月-2013年6月收治的18例脾动脉栓塞术后严重脾粘连行脾切除术的患者临床资料,分析手术时间、术中出血、术中特殊处理及术后恢复情况等。结果:18例患者均顺利恢复出院,无围手术期死亡,开腹后到脾切除完成平均耗时55 min、出血550 mL。术后并发症为腹水(8例)、肺部感染(1例)、胰瘘(1例)及腹腔内出血(1例)。结论:脾动脉栓塞术后出现严重脾粘连行脾切除术,手术风险较大,手术时间、术中出血较常规脾切除术明显延长、增多。规范手术操作,细致分离脾周粘连,合理处理脾蒂,是安全、有效完成此类脾切除术的关键。

Experience of Splenectomy in Severe Adhesions after Splenic Artery Embolization*

Objective： To explore the splenectomy surgical techniques in severe adhesions spleen after splenic artery embolization. Methods： A retrospective analysis about the clinical data of 18 patients who were applied the splenectomy surgery with severe adhesions by the splenic artery embolization in our hospital from April 2005 to June 2013 were conducted. Then the operation time, the blood loss, the intraoperative special treatment and the postoperative recovery were analyzed. Results： 18 cases were all successfully recovered and discharged without death. The average operation time was 55min and blood loss 550 mL. Postoperative complications were ascites （8 eases）, lung infection （one ease）, pancreatic fistula （one case） and intraperitoneal hemorrhage （one case）. Conclusions： Compared with conventional splenectomy, the surgical risk of splenectomy in severe adhesions after splenic artery embolization increased, the operation time prolonged and blood loss increased. The key to safe and effective surgery is normalized operation procedures, meticulous separation of spleen adhesions and rational treatment of spleen pediele.