Beal S L, Spisso J M
Department of Surgery, University of California, Davis Medical Center, Sacramento 95817.
Arch Surg. 1988 Sep;123(9):1158-63. doi: 10.1001/archsurg.1988.01400330138021.
The main reason for splenorrhaphy is to prevent the occurrence of overwhelming postsplenectomy sepsis. This fear of postsplenectomy sepsis has led to an enthusiasm for splenic salvage to the extent that it may be felt that the injured spleen must be saved at all costs. However, if that is valid, the complications that result from splenic salvage must not exceed the risk incurred by loss of this organ. To assess this, 119 splenic injuries treated by splenorrhaphy were reviewed. These were major splenic injuries that were actively hemorrhaging at laparotomy and, therefore, required specific operative intervention for hemostasis. There were 14 complications in 11 patients (11.8%) directly attributed to the splenorrhaphy. In one patient, the repaired spleen rebled 17 days postoperatively, necessitating splenectomy. Ten patients had persistent or recurrent bleeding, requiring blood transfusions. Three of these underwent reexploration for additional hemostasis. Blood transfusion in association with splenorrhaphy has not previously been considered a complication. However, the literature clearly documents that the risk of blood transfusion heavily outweighs the risk of postsplenectomy sepsis. Therefore, if blood transfusion becomes a necessary adjunct for successful splenorrhaphy, then splenectomy without transfusion is the safer treatment.
脾修补术的主要原因是预防脾切除术后暴发性感染的发生。对脾切除术后感染的担忧使得人们热衷于保留脾脏，甚至认为必须不惜一切代价挽救受损的脾脏。然而，如果这种观点成立，那么保留脾脏所带来的并发症绝不能超过因失去该器官而产生的风险。为了评估这一点，我们回顾了119例接受脾修补术治疗的脾损伤病例。这些都是在剖腹手术时出现活动性出血的严重脾损伤，因此需要进行特定的手术干预来止血。11例患者（11.8%）出现了14例直接归因于脾修补术的并发症。1例患者术后17天修补后的脾脏再次出血，不得不进行脾切除术。10例患者持续或反复出血，需要输血。其中3例因需要进一步止血而再次进行探查。此前输血一直未被视为脾修补术的并发症。然而，文献明确记载输血的风险远超过脾切除术后感染的风险。因此，如果输血成为成功实施脾修补术的必要辅助手段，那么不输血的脾切除术则是更安全的治疗方法。
