Spleen

[Outlined -- spleen is a rich blood supply and obscure the substantive organ. It has been linked with the various capsule ligament fixed in the upper left rear, although under the chest wall, diaphragm and abdominal wall protection But violence can easily traumatic rupture caused internal bleeding. According to various causes, spleen divided into two categories : the traumatic rupture, accounting for the majority, and have a clear history of trauma. location spleen laceration to the lateral convexity for many, but in the medial splenic hilum, the main role of violence depends on the orientation and location; Spontaneous rupture, very rare and mainly occurred in the pathological enlargement of the spleen; If we carefully recover with the history, Most still have certain incentives, such as severe coughing, sneezing or sudden changes in body position. [Diagnosis -- traumatic rupture of the diagnosis is mainly based on injury history; The clinical manifestations of hemorrhage; abdominal diagnostic puncture is not the quality, such as blood coagulation. Subcapsular splenic rupture with subcapsular hematoma cases, the clinical manifestation is not typical, abdominal puncture negative, the diagnosis can not be determined. In recent years, the diagnosis is indeed difficult, the seriousness of the case to allow using peritoneal lavage, B-mode ultrasound, isotope scanning, Abdominal CT or selective arteriography and other help clear diagnosis. (1) peritoneal lavage is a invasive inspection, and not specific organ damage positioning, but also could not explain the extent of injury. Meanwhile a handful of false positive or false negative results. Must be integrated with other clinical findings and analysis. (2) B-mode ultrasound is a non-invasive screening, more commonly used, could show a broken spleen, larger spleen subcapsular hematomas and abdominal bleeding. (3) CT scan can clearly show the spleen in the state, the diagnosis of splenic rupture or real subcapsular hematoma high accuracy. (4) use of radionuclide scanning technetium 99m sulfur colloid scan or photography diagnosis of splenic injury, the method is safe. (5) selective abdominal angiography This is a invasive inspection, a more complex operation, which is dangerous. However, the accuracy of diagnosis of splenic rupture high, showing spleen damaged artery and the real parts. Only for the seriousness of stability while other methods failed to clear diagnosis of blunt trauma. It should be emphasized that the spleen is often associated with other organ damage, such as liver, kidney, pancreas, stomach, intestine, in the diagnosis and treatment not omitted. 【Treatment -- since the 1960s, with the immunology of progress, it was recognized that the spleen is the largest body of the lymphoid organs, the human immune system is an important component of the humoral and cellular immune play an important role. Spleen is generated opsonin (opsonin) Phagocytosis serum hormone (tuftsin) and preparedness solutions - (properdin) of the vital organs, effective filtration and blood circulation to remove invasive pathogens. Splenectomy after the human immune system destruction of the integrity of bacteria resistance to inevitable decline prone to serious infections. Past that the treatment of splenic rupture the preferred method is the splenectomy, Many textbooks do think that, regardless of how splenic rupture have all splenectomy to testify. Along with fulminant infection after splenectomy (overwhelming postsplenectomy infection-OPSI) mainly in the children reported a gradual increase, The traditional concept of a challenge. Moreover, according to the anatomy of the spleen and existing hemostatic measures, spleen partial resection can be safe. Rupture of the current treatment principles still to surgery, but should be based on the extent of injury and then, maximize the use of different surgical methods, in whole or in part to retain the spleen. The following surgery under the specific circumstances of the injury selection : (1) repair of spleen spleen coating applied to linear laceration or real spleen laceration. Minor injuries adhesive can be used to stop bleeding, if not satisfied with the results to adopt repair. The key to the operation is the first step in fully free spleen, to enable them to make incisions, - induced vascular clamp fingers or spleen pedicle control flow, Fine with 1-0 or 3-0 Catgut suture active bleeding again suture point gap. Patch after the needle hole bleeding can be hot saline gauze oppression or deposited in hemostatic agents until the bleeding stopped completely. (2) of splenectomy in a simple patch to stop the bleeding or damage to the spleen has lost vitality, Some splenectomy after more than half of the spleen can be real reservation. Surgery should be fully free spleen, splenic pedicle control of the situation, with all the lost vitality spleen, respectively ligation or ligation of the bleeding, bleeding plane with hemostatic agents Application and hot saline gauze until the complete cessation of oppression, Finally pedicled omentum coverage. (3) all Splenectomy in the spleen or serious broken spleen and unsuitable for pedicle fracture repair or partial splenic resection. Appropriate preoperative preparation with shock to the rescue of the injured is of great significance. Importation of adequate blood or liquid can improve the wounded to surgical anesthesia and tolerance. If 600~800ml by the rapid importation of blood, blood pressure and pulse shows no improvement, suggest continued active bleeding, in need of blood transfusion rapid compression of emergency laparotomy control splenic stalk. Control bleeding after sexual activity, blood pressure and pulse will soon improve, further surgical treatment for the creation of the conditions. In the blood under difficult circumstances, the collection hemoperitoneum, filtered blood transfusion added easily. [Clinical manifestations -- rupture of the clinical manifestations of hemorrhage and blood caused by the stimulation of peritoneal feature, and often bleeding and blood velocity Contact closely related. A large amount of bleeding and fast soon appeared hemorrhagic shock, the seriousness of very critical; slow and less bleeding symptoms were mild, mild abdominal pain in 3825 with no other obvious signs, difficult to diagnose. With the passage of time, more and more the amount of bleeding, shock early stage before the performance, the resultant shock. As the blood of the peritoneum and abdominal pain stimulation, teachers at the upper left, gradually involve the abdomen, but still left upper most obvious, Meanwhile abdominal tenderness, anti-rectal and muscular tension. Sometimes stimulate blood left by the diaphragm which left shoulder pain involved, which involves deep breathing when the pain increased, namely Kehr levy. Laboratory tests showed erythrocytes, hemoglobin and hematocrit were reduced, suggesting a hemorrhage.