客观认识脾功能 合理开展脾手术

经过近半个世纪的研究,人们对脾脏的功能已有初步认识.从脾脏无用到保脾手术,以至今日的选择性保脾,我国脾脏外科取得了长足的发展,现代脾脏外科观念已被多数学者所接受.然而目前我们对脾功能的了解还是很少,脾脏外科中尚存在许多争议.不断探索和正确认识脾功能(生理及病理状态下)将有助于解决上述争议,以便针对不同情况采取最佳的治疗方式,合理开展脾手术.     

脾脏肿瘤的诊断与治疗

目的 探讨脾脏肿瘤的诊断与治疗。方法 收集和整理65例脾脏肿瘤的临床资料，对就诊原因、影像学检查、手术治疗所见及病理检查结果进行回顾性分析。结果 65例脾脏肿瘤中包括囊肿26例、良性肿瘤14例、恶性肿瘤25例，全部接受手术治疗，无手术死亡病例。各种影像学检查对绝大多数病人可给予术前确诊。结论 脾脏肿瘤的诊断主要依据左上腹痛、脾脏肿大等临床表现。影像学检查是发现肿瘤和确诊的重要方法，脾脏切除术是主要的治疗手段。     

Leiomyosarcoma of the splenic vein

Leiomyosarcomas are smooth muscle-derived tumors generally found intra-abdominally in the retoperitoneum, mesentery, or omentum. Only approximately 5% of these tumors originate from vessel wall smooth muscle. Those derived from the splenic vein are exceedingly rare, with only one previously published case in the literature. We present a second case of leiomyosarcoma of the splenic vein in a 58-year-old woman with 2 months of epigastric pain. A distal pancreatectomy was performed to include the tumor found centered in the splenic vein at the splenic and portal vein confluence and growing into the pancreas in the body on the posterior aspect. A saphenous vein patch was used for reconstruction.     

Aneurysm of the splenic artery

Two cases of multiple aneurysms of the splenic artery are reported. The aneurysms themselves were asymptomatic and the patients were operated upon for other reasons. In the first case the aneurysm was of an arteriosclerotic nature and in the second it coexisted with portal hypertension. The literature on this subject is briefly reviewed.     

Aneurysm of the splenic vein

Aneurysms of the portal venous system are increasingly reported in the past five years. Congenital weakness of the venous wall, trauma, pancreatitis and portal hypertension are possible etiologies. Surgical intervention is indicated in case of symptomatic aneurysms with or without progressive expansion of the aneurysm diameter. The treatment of asymptomatic splenic vein aneurysms remains debated. We report the case of an asymptomatic and uncomplicated splenic vein aneurysm for which a conservative approach was advocated with regular follow-up by means of Doppler ultrasonography. After six years of follow-up the aneurysm diameter has not changed and no complications were observed.     

Immune function and the role of vaccination after splenic artery embolization for blunt splenic injury

The spleen is the most commonly injured solid organ following blunt abdominal trauma. Over recent decades, splenic artery embolization (SAE) has become the mainstay treatment for haemodynamically stable patients with high-grade blunt splenic trauma, with splenectomy the mainstay of treatment for unstable patients. Splenic function is complex but the spleen has an important role in immune function, particularly in protection against encapsulated bacteria. Established evidence suggests that following splenectomy immune function is impaired resulting in increased susceptibility to overwhelming post-splenectomy infection, however, immune function may be preserved following SAE. This review will discuss the current state of the literature on immune function following different treatments of blunt splenic injury, and the controversies surrounding what constitutes a quantitative test of splenic immune function.     

Evaluation of splenic circulation after spleen-preserving distal pancreatectomy by dividing the splenic artery and vein

BACKGROUND/AIM: In the present study, we investigated the acute and late phases of splenic circulation after spleen-preserving distal pancreatectomy (SPDP) involving the division of splenic vessels. METHODS: An acute phase of splenic circulation was evaluated by laser flow meter and the late phase was estimated by (99m)Tc-galactosyl human serum albumin spleen scintigraphy. RESULTS: Splenic blood supply, evaluated by laser flow meter immediately after SPDP, dropped to one half of the prior blood supply. However, blood supply recovered 10 days after SPDP, as estimated by (99m)Tc-galactosyl human serum albumin spleen scintigraphy. CONCLUSION: There are two variations of SPDP: SPDP without preservation of the splenic artery and vein, and SPDP with preservation of the splenic artery and vein. The disadvantage of the former is the resulting decrease in splenic blood supply. The present findings may help to make up for this disadvantage.     

Efficacy of clinical evaluation and selective splenic arteriography in splenic trauma

The diagnosis of splenic injury after blunt trauma, although clear in most instances, is difficult to make in 16 per cent of our patients.We selected sixty patients who sustained blunt trauma between January 1968 and December 1971 from a large group of patients with multiple system injuries on the basis of isolated splenic injury. Fifty of these patients were evaluated by the usual clinical methods and had splenectomy on the day of admission. Reliable diagnostic criteria are abdominal pain, tenderness localized to the left upper abdomen, fractures of the ninth, tenth, eleventh, and twelfth ribs posteriorly on the left, and evidence of hypovolemia.Ten other patients had initial clinical assessment that cast doubt on the diagnosis of splenic rupture. The splenic artery was selectively catheterized in this group of patients and an arteriogram obtained. Eight arteriograms were positive for splenic trauma. At surgery these arteriographic findings correlated with the splenic disorder in all instances. Two patients had normal arteriograms and were not subjected to surgery.When clinical evaluation precipitates reasonable doubt in the diagnosis of splenic trauma, selective splenic arteriography is an added dimension with marked reliability.