Spleen repair

Spleen injury or rupture caused by direct or indirect external force may occur in closed abdominal injury (abdominal skin integrity, abdominal cavity without contact with the outside world), or open abdominal injury (abortion of abdominal skin loss) The abdominal cavity communicates with the outside through the wound). At this time, spleen repair should be urgently performed to avoid spleen necrosis. Treatment of diseases: traumatic spleen rupture spleen rupture Indication 1. Spleen laceration caused by surgical operations such as stomach and colon. This type of crack is often small and shallow. 2. When the traumatic spleen ruptures, the spleen is small and shallow, and the depth is generally less than 1.5cm. 3. When partial splenectomy is performed, a small rupture of the spleen remains. 4. A small gap for the spleen to appear when the organ is harvested by allogeneic spleen transplantation. 5. After the spleen is subcutaneous hematoma incision, the spleen is shallow and small. Contraindications 1. Combine abdominal cavity contamination caused by damage to hollow organs. 2. The spleen is extensively ruptured, and the spleen or spleen is broken, or the spleen and segmental vessels are damaged, and the repair can not be repaired. 3. Pathological splenomegaly occurs spontaneous spleen rupture. Preoperative preparation 1, the conventional saphenous vein or external jugular vein incision, the latter on the one hand can quickly infusion of blood to the emergency; on the other hand, the central venous pressure can be measured for the choice of infusion volume and type. 2, urgently do the necessary laboratory tests, such as blood routine, blood type, clotting time, urine routine, X-ray chest and abdomen perspective. 3, match the blood and quickly input the same type of blood, before the blood transfusion can be rehydration. 4. Place the stomach tube and the urinary tube at the same time as the blood transfusion. 5, give hemostatic drugs, such as vitamin K, phenethylamine (hemostatic) or anti-fibrinolytic acid. Surgical procedure Surgical points (1) Position: After anesthesia, take the flat position, and the left rib spleen area soft pillow. (2) Incision: a median incision or a trans-abdominal rectus incision in the left upper abdomen, or a Kocher incision in the left rib arch. The upper end of the left upper abdomen straight incision may extend along the rib arch to the xiphoid direction, or the lower end of the incision may be extended to the outer side in an "L" shape; or the middle of the straight incision may be added to the left side into a "" shape. (3) Exploring the abdominal cavity, judging the injury: exhausting the blood in the abdominal cavity. If it is a closed injury, if the hollow organ injury is not combined, the blood in the abdominal cavity can be collected for autologous reinfusion. Then, explore the location and extent of spleen injury, and pay attention to other organs with or without damage, such as the left kidney, liver and digestive organs. (4) Control bleeding: quickly move the left hand into the abdominal cavity, indicating that the finger extends from the top to the back of the spleen, pinch the spleen, control the bleeding, and completely remove the clot. (5) Fully revealing the spleen: Never blindly use your fingers to bluntly release the spleen to cause new damage to the spleen. The surgeon uses the right hand to lift the spleen forward and downward, while using the spleen pad or large gauze to cushion the spleen. (6) Carefully suture the spleen: cut off the inactivated tissue under direct vision, but do not perform debridement. The thick non-absorbent silk thread and the liver needle are used to suture the split, and the suture is often used to tie the knot together. Before the knotting, it can be inserted into the absorbent gelatin sponge or the omentum to obtain a satisfactory hemostasis effect. For the deeper crack, for the sake of safety, the horizontal suture can be sutured first, followed by the nodule suture. (7) Carefully wipe the abdominal cavity: remove the spleen pad, put the spleen back in place, and check for new tears during operation. Finally, the abdominal cavity was flushed with isotonic saline. (8) Place the drainage and suture the incision: Place 1~2 drainage tubes around the spleen and close the abdominal cavity.