摘要
目的探讨保留脾脏治疗小儿脾损伤的可行性和安全性。方法总结分析116例小儿脾损伤施行医用胶粘涂、脾修补、脾动脉结扎加脾修补(Ⅰ组),脾部分切除、脾部分切除+脾动脉结扎、脾切除自体脾组织片网膜内移植术(Ⅱ组)和非手术(Ⅲ组)患儿的临床及随访资料。结果Ⅱ组术后3周血小板计数较术前及其他两组明显增高(P<0.05),手术6月后降至正常水平;Ⅱ组血液痘痕红细胞计数术后3周、6个月及2年以上较术前均增加(P<0.05),Ⅰ组仅术后3周随访高于正常;免疫功能检查,Ⅱ组IgM在术后3周、IgA术后6月内低于术前。B超、CT或核素扫描:6月内脾裂伤完全愈合Ⅰ组95%,Ⅲ组占95.2%。Ⅲ组术后6月以上移植脾块显像清晰,成活脾块占植入总数的97.3%,其中94.5%脾块明显增大。本组114例治愈,2例患儿因严重合并伤于围手术期死亡。术后肺部感染、切口感染各2例,4例膈下感染,1例非手术治疗中转手术,3例术后发生粘连性肠梗阻,未见其他并发症。2年内因感染到医院就诊频次各组间无明显差异。结论小儿脾损伤选用恰当的方式保脾治疗,安全、有效,远期并发症少。
Aim To study the practicability and safety of the spleen-retaining for pediatric splenic injuries.Methods A retrospective analysis and follow-up study were made of 116 children patients with splenic injury treated with spleen-preservation techniques.According to the different treatment,all patients were divided into 3 groups：the patients in Ⅰgroup received the gum to stick the wound,or repaired the wound,or ligated the spleen artery plus repairing the wound of the splenic injuries;Ⅱgroup received partial splenectomy,or plus ligating the spleen artery,or autoplasty of spleen after excision of spleen;and Ⅲ group only for non-operative patients.Results Platelet counts of Ⅱ group in 3 weeks after operation compared with those of preoperation and the other two groups were significantly higher（P〈0.05）,and 6 months after operation the counts back to normal levels.Ⅱ group of blood pocked red cell count after 3 weeks,6 months and 2 years were increased compared with the preoperative（P〈0.05）,while those of Ⅰgroup only 3 weeks after operation are higher than normal.IgM was lower in groupⅡ3 weeks after operation than that in preoperation,IgA of groupⅡwas lower in 6 months.Six months after the operation,B mode ultrasonography,CT and nuclide scintiscanning showed that complete healing of splenic laceration in groupⅠwas 95%,and Ⅲ group accounted for 95.2%.The autotransplanted spleen exhibited good scintigram in Ⅲ group after 6 months or more.The group of 114 patients were cured,2 cases of children died of severe associated injuries in the perioperative.In this study,12 cases of postoperative complications occurred,which accounted for 7.02% of various infections,no OPSI.The frequency to the hospital due to infection in two years had no significant difference between groups.Conclusion Spleen-preserving treatment of splenic injury in children in an appropriate way is safe and effective.
出处
《安徽医药》
CAS
2011年第8期967-970,共4页
Anhui Medical and Pharmaceutical Journal
关键词
小儿
脾损伤
治疗
随访
children
splenic injury
treatment
follow up
