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OPERATION OF RETAINING SPLEEN FOR SPLEEN TRAUMA (REPORT OF 77 CASES)

目的 探讨外伤性脾破裂手术适应证和方法。方法 对77例外伤性脾破裂进行保脾手术治疗，按姜洪池脾损伤四级分类法： Ⅰ级8例，Ⅱ级41例，Ⅲ级18例，Ⅳ级10例。附加脾动脉结扎术6例。结果 死亡4例； 2例并粘连性肠梗阻。获随访45例，随访时间3个月至3年，仅4例儿童有反复上呼吸道感染，无1例发生脾切除后凶险感染(OPSI)。结论 根据脾损伤的部位和程度，可采用两种以上的联合保脾术式，对控制伤脾出血及保留脾脏功能有重要价值。

脾脏原发性恶性肿瘤（附8例报告）

腹腔镜保留脾脏胰体尾切除术(附7例报道)

目的探讨经腹腔镜下保留脾脏胰体尾切除术（LSPDP）在治疗胰腺体尾部良性肿瘤的可行性及手术技巧。 方法对我院2009年6月至2013年12月期间行LSPDP治疗7例胰腺体尾部良性肿瘤患者的临床资料进行回顾性分析。 结果7例均无中转开腹，平均手术时间218.57 min（120～300 min），术中平均出血量135.71 mL（50～300 mL），术后平均住院时间12.14 d（7～21 d）。术后2例B级胰瘘，经充分引流后出院；1例脾下极局灶性梗死，经保守治疗后治愈。术后病理诊断：胰腺浆液性囊腺瘤4例，胰腺神经内分泌肿瘤3例。术后随访12～48个月，均未出现脾梗死和食管胃底静脉曲张、出血。 结论对胰腺体尾部良性肿瘤患者行LSPDP具有恢复快、并发症少等优点。

射频消融在脾脏外伤后保脾手术中的临床应用

目的 探讨射频消融在保脾手术治疗脾脏外伤中的临床应用效果。 方法 回顾性分析笔者所在医院科室于 2010 年 7 月至 2015 年 3 月期间行保脾手术治疗的 23 例脾脏外伤患者的临床资料，术中均利用了射频消融技术。 结果 23 例患者均保脾成功，其中 11 例行射频消融止血修补术，12 例行射频消融联合部分脾脏切除术。手术时间为 75～150 min，平均 117 min；术中出血量为 40～500 mL，平均 223 mL；术中见腹腔出血量 800～2 000 mL，平均 1 452 mL，均行自体血回输；术中见脾脏裂伤程度：Ⅰ 度 10 例，Ⅱ 度 11 例，Ⅲ 度 2 例；拔除引流管时间为术后 2～5 d，平均 2.8 d；术后住院时间为 6～15 d，平均 8.5 d。术后出现发热 3 例，腹腔再次出血 1 例，血小板计数升高 7 例。术后获访 16 例，随访时间 8～26 个月，中位数为 11 个月。随访期间患者健康情况良好，未见血小板计数异常、脾脓肿等情况。 结论 射频消融在保脾手术治疗脾脏外伤中的应用是可行的。

Application and Experience of Laparoscopic Partial Splenectomy: Report of 11 Cases

ObjectiveTo explore the clinical efficacy and experience of laparoscopic partial splenectomy. MethodsThe clinical data of 11 cases of splenic space occupying lesions in the author's hospital from January 2011 to May 2014 were retrospectively analyzed. Laparoscopic partial splenectomy were carried out in 11 patients. ResultsEleven patients were successfully completed the laparoscopic partial resection of spleen. Operative timewas 2.0-3.5 h, the average operative time was (2.5±0.3) h. Intraoperative blood loss was 155-320 mL, the average blood loss was (200.3±55.1) mL. Eleven patients who ride smoothly, there was no case of pancreatic injury, gastrointestinal injury, major bleeding and other complications. Postoperative patients recovered well, 24 h after operation gastrointestinal function recovery, and can get out of bed activities. Silicone drainage tube placement time was 3-5 d, the average for placing time was (4.0±1.3) d. about 60-100 mL, the average (70.3±15.8) mL. The average length in hospital was 5-8 d, patients with an average of (6.3±1.5) d, all of the patients without postoperative complications such as infection, splenic infarction. Postoperative pathologic results suggested 6 cases were spleen hemangioma, 3 cases were pseudocyst of spleen, and 2 cases were true epithelial cyst. Conciusions Laparoscopic partial spleen resection should fully grasp the operative indication, fully understand the pathological changes and the structure of door of the spleen, in earnest and patient, under the operation of laparoscopic spleen resection is safe, feasible, and the clinical curative effect is satisfied, worthy of clinical popularization and application.

Risk factors for intraoperative massive hemorrhage in patients with pancreatitis-induced sinistral portal hypertension

ObjectiveTo analyze risk factors of intraoperative massive hemorrhage in patients with pancreatitis-induced sinistral portal hypertension (SPH) and to explore its strategies of treatment.MethodsThe clinical data of patients with pancreatitis-induced SPH admitted to the West China Hospital of Sichuan University from January 2015 to March 2018 were retrospectively analyzed. The intraoperative massive hemorrhage was defined as the blood loss exceeding 30% blood volume. The factors closely associated with the intraoperative massive hemorrhage were analyzed by the forward logistic regression model.ResultsA total of 128 patients with pancreatitis-induced SPH were enrolled in this study, including 104 males and 24 females, with an average age of 47 years old and a median intraoperative bleeding volume of 482 mL. Among them, 93 patients with pancreatitis-induced SPH caused by the pancreatic pseudocyst after acute pancreatitis and 35 caused by the chronic pancreatitis. There were 36 patients with history of upper gastrointestinal bleeding and 46 patients with hypersplenism. Thirty-six patients suffered from the massive hemorrhage. Among them, 30 patients underwent the distal pancreatectomy concomitant with splenectomy, 1 patient underwent the duodenum- preserving resection of pancreatic head, and 5 patients underwent the pseudocyst drainage. The univariate analysis showed that the occurrence of intraoperative massive hemorrhage in the patients with pancreatitis-induced SPH was not associated with the gender, age, body mass index, albumin level, upper gastrointestinal bleeding, hypersplenism, type of pancreatitis, course of pancreatitis, number of attacks of pancreatitis, size of spleen, maximum diameter of lesions in the splenic vein obstruction site, or number of operation (P>0.05), which was associated with the diameter of varicose vein more than 5.0 mm (χ2=19.83, P<0.01), the intraperitoneal varices regions (χ2=13.67, P<0.01), the location of splenic vein obstruction (χ2=5.17, P=0.03), the operation time (t=–3.10, P<0.01), or the splenectomy (χ2=17.46, P<0.01). Further the logistic regression analysis showed that the varicose vein diameter more than 5.0 mm (OR=6.356, P=0.002) and splenectomy (OR=4.297, P=0.005) were the independent risk factors for the intraoperative massive hemorrhage in the patients with pancreatitis-induced SPH.ConclusionsSplenectomy and having a collateral vein more than 5.0 mm in diameter are independent risk factors for intraoperative massive blood loss in surgeries taken on patients with pancreatitis-induced SPH. Attention should be paid to dilation of gastric varices and choice of splenectomy.

Retaining of Spleen and Sweeping of Lymph Nodes of No.10 and No.11 During the Operation of Gastric Carcinoma

ObjectiveTo study the indication and means in dissection lymph nodes of the No.10 and No.11 without splenectomy in radical gastrectomy for gastric cancer. MethodsAccording to the location, type of pathology, clinical and pathological classification, lymphatic drainage and spread of gastric carcinoma togather with the immunological function of spleen, selection of operative procedure without splenectomy should be considered, so the related literatures were reviewed. ResultsRetained spleen had been shown to improve 5year survival of patients with gastric cancer of stage Ⅰ,Ⅱ and Ⅲ,splenectomy had been shown to improve 5year survival of patients with gastric cancer of stage Ⅳ,whose carcinoma was infiltrating splenic and the lymph nodes of the No.10. The complications of different means of dissection of the lymph nodes made no difference.Conclusion Dissection of the lymph node without retained spleen or allogenic spleen transplantation is indicated for the patients with cancer of stage Ⅳ,whose spleen is invaded by the tumor.

射频凝血器行脾部分切除术治疗脾脏占位一例

Indications and Techniques of Spleen-Preserving Distal Pancreatectomy

ObjectiveTo investigate the feasibility and safety of spleen-preserving distal pancreatectomy (SpDP), and to discuss the indications and techniques of SpDP. MethodsThe clinical data of seven patients underwent SpDP between January 2004 and December 2007 in Xinhua Hospital were analyzed retrospectively. ResultsOut of the seven cases, one case received the SpDP combined with partial splenic vessel resection, while the other cases received the SpDP with splenic vessel preservation. The operation time was (2.93±0.38) h and the intraoperative blood loss was (392.86±109.65) ml. Only one case suffered from pancreatic fistula, who finally recovered after medicine therapy and percutaneous drainage. There was no other complication or operative mortality. The postoperative platelet count was (273±43.76)×109/L and the postoperative hospital stay was (17.86±8.07) d. For six cases of patients, no recurrence and metastasis was found after the followup (49.2±14.4) months （30-72 months）. ConclusionSpDP is a safe and feasible procedure, which is worthy for selected cases such as benign neoplasm of the body and tail of the pancreas.

胰腺炎脾血管并发症的解剖与诊断进展

胰腺炎脾血管并发症是较为常见的胰腺炎血管并发症，其发生率虽不高，却是胰腺炎病情重危程度、预后不良的征象之一，如脾动脉假性动脉瘤破裂可危及患者的生命。因此对于胰腺炎脾血管并发症的准确诊断就显得特别重要。超声作为急性胰腺炎检查中最常用的手段，由于易受胃肠道麻痹致腹内胀气、腹膜后血管彩色血流衰减、检查者经验和手法等原因的影响，导致超声对于胰腺炎脾血管并发症的诊断准确率较低。现通过文献复习，对该病的发生、发展以及诊断的进展进行综述，以提高超声医师对该疾病的认识，提高诊断的准确性。