目的 探讨腹腔镜下脾切除术（LS）治疗特发性血小板减少性紫癜(ITP)的临床效果。方法 我院2003年1月至2008年8月期间行LS治疗ITP患者20例，将术前与术后1、2、7、14、30、90及180 d的血小板计数进行比较。结果 20例ITP患者均顺利完成LS，平均手术时间为156 min，术中出血平均50 ml，平均住院时间为9 d。完全停用药物14例； 4例患者术后需继续服用激素治疗，但激素用量较前明显减少； 无效2例。总有效率为90%。术后1、2、7、14、30、90及180 d的血小板数量分别为(251.6±91.4)×109/L、(312.6±90.1)×109/L、(343.2±103.7)×109/L、(300.0±98.2)×109/L、(175.6±42.6)×109/L、(151.8±42.1)×109/L及(207.0±53.4)×109/L,分别与术前〔(38.3±19.4)×109/L〕比较，经t检验，差异均有统计学意义（P＜0.001）。结论 LS治疗ITP是可行和安全的，手术效果满意。
Objective To analyze the effect of monitoring and modulating the portal vein pressure and blood flow during living donor liver transplantation （LDLT） on preventing small-for-size-syndrome (SFSS). Methods Data of forty-four LDLT recipients between Oct.2007 and Oct.2008 were reviewed. Actual graft-to-recipient weight ratio（GRWR）, portal vein flow and pressure during operation and syndrome of SFSS after operation were recorded. The patients received splenectomy or splenic artery ligation according to actual GRWR, portal vein flow and pressure and WBC. Relationships between patients’ GRWR, portal vein flow, portal vein pressure and occurrence of SFSS were analyzed. Results Six patients received splenectomy and 7 patients received splenic artery ligation to decrease the portal vein flow and pressure during the operation. The portal vein flow and pressure decreased after splenectomy （Plt;0.05）. The portal vein pressure decreased （Plt;0.05） and the portal vein flow had no significant change after splenic artery ligation （P＞0.05）. No SFSS occurred after operation. Conclusion Modulation of portal vein flow and pressure by splenectomy or splenic artery ligation during LDLT operation can decrease the portal vein flow and pressure, and which can prevent the incidence of SFSS.
ObjectiveTo investigate the safety and feasibility of the treatment of laparoscopic splenectomy for patients with traumatic splenic rupture. MethodsBetween October 2006 and October 2009, 48 cases of traumatic splenic rupture underwent laparoscopic splenectomy were analyzed in this hospital. According to the differrent styles of splenic stalk, different operative methods were taken， including titanic clipping in 12 cases， titanic clipping combining silk suture ligation in 8 cases， snare combining titanic clipping in 10 cases， LigaSure in 8 cases， and EndoGIA in 8 cases. ResultsLaparoscopic splenectomy was successfully completed in 32 cases; Handassisted laparoscopic splenectomy was applied in 14 cases, and 2 cases were converted to laparotomy because of tight spleen adhesion with surrounding tissues and bleeding rupture of the short gastric vessels. The operation time was 120－170 min with an average 140 min; the estimated intraoperative amount of blood loss was 300－1 200 ml with an average 800 ml. No postoperative complication occurred such as gastric fistula, pancreatic fistula or hemorrhage. Conclusion According to the differrent styles of splenic stalk, individual operative method can improve mission success rate in the laparoscopic splenectomy in traumatic splenic rupture.
目的探讨腹腔镜技术在治疗外伤性脾破裂中的可行性和安全性。 方法回顾性分析笔者所在医院2012年3月至2014年3月期间应用腹腔镜技术救治的19例外伤性脾破裂患者的临床资料。 结果本组19例患者中，顺利完成腹腔镜手术17例，中转开腹2例，均获得成功救治，痊愈出院。其中行腹腔镜下电凝止血＋生物蛋白胶黏合保脾4例，行腹腔镜下无损伤线缝合＋网膜覆盖保脾8例，行腹腔镜脾切除术5例，中转开腹行脾切除术2例。手术时间50～186 min，平均90 min；术中失血250～2 200 mL，平均780 mL；术后住院时间7～26 d，平均13.5 d，术后均无并发症发生。术后19例患者均获访，随访时间为3～12个月，平均8个月。随访期间无死亡及远期并发症发生。 结论对外伤性脾破裂患者选择性施行的腹腔镜脾修补术和脾切除术具有良好的效果，其具有创伤小、痛苦轻及恢复快的优点，安全而可行，值得推广。
Objective To explore the cause, diagnosis, and treatment methods of portal vein thrombosis （PVT） after splenectomy. Methods The clinical data of 29 patients who were got splenectomy because of portal hypertension or traumatic splenic rupture from August 2002 to August 2008 in our hospital were analyzed retrospectively. Results Tweenty-seven patients with PVT were treated successfully, whose thrombi were absorbed completely or partially. One case died of peritonitis，septic shock，and multiple organ failure. One case died of hematemesis, hepatic coma，and multiple organ failure. Tweenty-four patients were followed up, the follow-up time was 0.5 to 3 years, the average was 2 years. Two cases died of massive hemorrhage, 1 case died of hepatic encephalopathy，and 1 case died of liver failure. Two cases occurred deep venous thrombosis in one year after treatment, and the remaining patients had no recurrence of venous thrombosis. Conclusions PVT have some connection with the raise of blood platelet and the hemodynamic changes of the portal vein system after splenectomy. Standardization of operation, early diagnosis, early line anticoagulant，and antiplatelet adhesion therapy are effective way to prevent and treat PVT.
Objective To defect the level of platelet antibody-IgG (PA-IgG) in patients with congestive splenomegaly and hypersplenism and the change of PA-IgG level after splenectomy and subtotal splenectomy. Methods Twenty four cases of congestive splenomegaly and hypersplenism were investigated. Results The level of PA-IgG in 24 cases were higher than normal range (Ｐ＜0.01), while the platelet count were lower than normal range and there was a significant negative correlation between the level of PA-IgG and platelet count (r＝-0.4747, Ｐ＜0.05). After subtotal splenectomy or splenectomy, the level of PA-IgG descended, the platelet count raised and the negative correlation between the level of PA-IgG and platelet count disappeared. Conclusion The results suggest that there is a immunoregulation between PA-IgG and platelet. Perhaps spleen has some relation with the immunoregulation.
目的 探讨脾占位性病变的临床诊断特点和治疗对策。方法 回顾性分析68例脾占位性病变患者的临床资料。结果 超声和CT是诊断脾占位性病变的主要方法。68例脾占位性病变中良性48例，恶性20例。手术治疗47例，其中脾切除37例，脾切除加胰尾切除2例，脾部分切除3例，脾切除加脾窝引流4例，单纯脾囊肿去顶减压1例。1例脾脓肿行脾切除术后发生肺部感染，经抗感染治疗后痊愈； 1例脾脓肿行脾切除术后，发生脾窝脓肿，感染严重，被迫再次开腹行脓肿引流术，其余良性病变经手术治疗后效果好； 恶性病变术后效果差。结论 脾占位性病变良性多见，恶性少见； 影像学检查是诊断脾占位性病变的主要手段。脾切除对成年人是一种有效的治疗方法，良性预后好，恶性预后差； 对儿童、青少年脾良性病变，脾部分切除是一种很好的选择。