Steele M, Lim R C
Am J Surg. 1975 Aug;130(2):159-65. doi: 10.1016/0002-9610(75)90364-5.
Because there is no such thing as "minor splenic injury", the diagnosis of splenic rupture is a major problem after abdominal trauma. Since it is our policy to explore all penetrating abdominal injuries, the problem of early recognition arises in patients with blunt trauma. When abdominal evaluation is difficult because of associated injuries, we increasingly use peritoneal dialysis. This has been particularly helpful in patients with head injury or drug intoxication and has also contributed to earlier operation in patients with signs of hypovolemia but minimal abdominal findings. Angiography has been useful in doubtful cases. Review of our experience in the last five years with splenectomy (298 cases) has revealed complications, particularly thromboembolic, that have changed our management of these patients. The incidence of clinical pulmonary embolism was 4 per cent in patients having splenectomy for trauma as contrasted with 0.5 per cent in patients having laparotomy for trauma without splenectomy. Postoperative platelet evaluations in patients after splenectomy for trauma revealed thrombocytosis. Detailed follow-up platelet studies showed a peak thrombocytosis at about two weeks, averaging 976,000/mm3. In contrast, similar studies in other patients having laparotomy for trauma showed counts of about 200,000/mm3. Because of the high incidence of thromboembolic complications, a low-dose heparin regimen was initiated. There was a 30 per cent incidence of infection postoperatively.
由于不存在“轻度脾损伤”这种情况，脾破裂的诊断是腹部创伤后的一个主要问题。鉴于我们的方针是对所有穿透性腹部损伤进行探查，钝性创伤患者就出现了早期识别的问题。当因合并伤而难以进行腹部评估时，我们越来越多地采用腹腔灌洗。这对头部受伤或药物中毒的患者特别有帮助，也有助于对有血容量不足体征但腹部检查结果轻微的患者更早地进行手术。血管造影在疑难病例中很有用。回顾我们过去五年行脾切除术（298例）的经验，发现了一些并发症，尤其是血栓栓塞并发症，这改变了我们对这些患者的处理方式。因创伤行脾切除术的患者临床肺栓塞发生率为4%，而因创伤行剖腹手术但未行脾切除术的患者为0.5%。创伤后行脾切除术患者的术后血小板评估显示血小板增多。详细的随访血小板研究显示，血小板增多高峰约在两周时出现，平均为976,000/mm³。相比之下，其他因创伤行剖腹手术患者的类似研究显示计数约为200,000/mm³。由于血栓栓塞并发症的发生率很高，开始采用小剂量肝素治疗方案。术后感染发生率为30%。
