Aim To study the practicability and safety of the spleen-retaining for pediatric splenic injuries. Methods A retrospective arnnalysis and follow-up study were made of 116 children patients with splenic injury treated with spleen-preservation techniques. According rnto the different treatment,all patients were divided into 3 groups:the patients in Ⅰ group received the gum to stick the wound,or repaired rnthe wound,or ligated the spleen artery plus repairing the wound of the splenic injuries; Ⅱ group received partial splenectomy, or plus ligarnting the spleen artery, or autoplasty of spleen after excision of spleen; and Ⅲ group only for non-operative patients. Results Platelet rncounts of Ⅱ group in 3 weeks after operation compared with those of preoperation and the other two groups were significantly higher( P ＜rn0.05 ),and 6 months after operation the counts back to normal levels. Ⅱ group of blood pocked red cell count after 3 weeks,6 months rnand 2 years were increased compared with the preoperative( P ＜ 0.05 ),while those of I group only 3 weeks after operation are higher rnthan normal. IgM was lower in group Ⅱ 3 weeks after operation than that in preoperation, IgA of group Ⅱ was lower in 6 months. Six months rnafter the operation, B mode ultrasonography, CT and nuclide scintiscanning showed that complete healing of splenic laceration in group Ⅰ rnwas 95％ ,and Ⅲ group accounted for 95.2％. The autotransplanted spleen exhibited good scintigram in Ⅲ group after 6 months or more.rnThe group of 114 patients were cured,2 cases of children died of severe associated injuries in the perioperative. In this study, 12 cases of rnpostoperative complications occurred,which accounted for 7.02％ of various infections,no OPSI. The frequency to the hospital due to inrnfection in two years had no significant difference between groups. Conclusion Spleen-preserving treatment of splenic injury in children rnin an appropriate way is safe and effective.%目的 探讨保留脾脏治疗小儿脾损伤的可行性和安全性.方法 总结分析116例小儿脾损伤施行医用胶粘涂、脾修补、脾动脉结扎加脾修补(Ⅰ组),脾部分切除、脾部分切除+脾动脉结扎、脾切除自体脾组织片网膜内移植术(Ⅱ组)和非手术(Ⅲ组)患儿的临床及随访资料.结果 Ⅱ组术后3周血小板计数较术前及其他两组明显增高(P＜0.05),手术6月后降至正常水平;Ⅱ组血液痘痕红细胞计数术后3周、6个月及2年以上较术前均增加(P＜0.05),Ⅰ组仅术后3周随访高于正常;免疫功能检查,Ⅱ组IgM在术后3周、IgA术后6月内低于术前.B超、CT或核素扫描:6月内脾裂伤完全愈合Ⅰ组95%,Ⅲ组占95.2%.Ⅲ组术后6月以上移植脾块显像清晰,成活脾块占植入总数的97.3%,其中94.5%脾块明显增大.本组114例治愈,2例患儿因严重合并伤于围手术期死亡.术后肺部感染、切口感染各2例,4例膈下感染,1例非手术治疗中转手术,3例术后发生粘连性肠梗阻,未见其他并发症.2年内因感染到医院就诊频次各组间无明显差异.结论 小儿脾损伤选用恰当的方式保脾治疗,安全、有效,远期并发症少.
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