Kairaluoma M I, Tarkka M, Mokka R E, Huttunen R, Nuutinen L, Ala-Ketola L, Larmi T K
Ann Chir Gynaecol. 1977;66(3):154-159.
71 patients with traumatic splenic rupture are reported. Most had severe associated injuries. In 44 patients the mechanism of trauma was blunt, in 10 penetrating, and in 17 iatrogenic, occurring most commonly (11/17) during operations for peptic ulcer. Splenectomy gave use to thrombocytosis which reached its peak about 2 weeks and returned to normal within one month after operation. Postoperative complications occurred in 24 of the 60 surviving patients (40%) of which most, 17 patients (30%) were infectious in origin. One patient developed deep venous thrombosis. Mortality was 16%. Associated injuries were the main cause of death in most patients (9/11), the ruptured spleen being responsible for only 2 deaths. None of the 17 patients with injury to the spleen alone died, whether associated with fractures of the left lower ribs or not. Primary unconsciousness, shock on admission, and multiple injuries, especially renal and hepatic, increased the mortality rate markedly. The necessity of drainage, the possibility of increased susceptibility of splenectomized patients to infection and thromboembolic complications and their prevention are briefly discussed.
本文报告了71例创伤性脾破裂患者。多数患者伴有严重的合并伤。44例患者的创伤机制为钝性伤，10例为穿透伤，17例为医源性损伤，最常见于（11/17）消化性溃疡手术期间。脾切除术后出现血小板增多症，约2周时达到峰值，术后1个月内恢复正常。60例存活患者中有24例（40%）发生术后并发症，其中多数（17例，30%）为感染性并发症。1例患者发生深静脉血栓形成。死亡率为16%。多数患者（9/11）的主要死亡原因是合并伤，脾脏破裂仅导致2例死亡。17例单纯脾损伤患者无论是否合并左下肋骨骨折均无死亡。入院时原发性昏迷、休克以及多发伤，尤其是肾和肝损伤，显著增加了死亡率。本文简要讨论了引流的必要性、脾切除患者对感染和血栓栓塞并发症易感性增加的可能性及其预防措施。
