What Can I Expect After Spleen Surgery?
The spleen is an easily damaged organ in the abdominal cavity. It has the functions of hematopoietic, hemofiltration, endocrine, immunity, antitumor, storage of red blood cells, platelets and lymphocytes. The spleen is not only an important immune organ, but also regulates various physiological functions of the liver. It plays a role with other organs and is a multifunctional organ.
- Chinese name
- Splenectomy
- Application
- Spleen rupture, swimming spleen
- Symptom
- Local spleen infection or tumor
- Field
- medicine
- The spleen is an easily damaged organ in the abdominal cavity. It has the functions of hematopoietic, hemofiltration, endocrine, immunity, antitumor, storage of red blood cells, platelets and lymphocytes. The spleen is not only an important immune organ, but also regulates various physiological functions of the liver. It plays a role with other organs and is a multifunctional organ.
Causes and common diseases of splenectomy
- The spleen is located deep inside the ribs on the lower left side of the thorax. Due to its fragile texture, the incidence of spleen injury is also high in various abdominal traumas, mainly traffic accident injuries, fall injuries, blow injuries, bruises, knife injuries, etc. . Among abdominal injuries, the spleen rupture is more serious, and it is often combined with other organ injuries. The clinical manifestations are complicated and the mortality is high. According to the different causes of spleen injury, it can be divided into three categories: traumatic spleen injury, iatrogenic spleen injury and spontaneous spleen injury. Most spleen injuries are caused by trauma. Traumatic spleen injury can be divided into two types: open spleen injury and closed spleen injury. The severity depends on the type and extent of the injury. The most common is the rupture of the spleen parenchyma and spleen envelope, as well as rupture of the spleen envelope.
Differential diagnosis of splenectomy
- Spleen injury is generally divided into complete rupture, central rupture, and subcapsular rupture. Complete rupture CT showed enlarged spleen volume, irregular shape, irregular low-density shadows in the spleen parenchyma, low-density shadows in the liver-kidney space, and around the liver and spleen. Central rupture CT manifests as a localized low-density or slightly high-density area of the spleen, and the realm may not be clear, but later on, the realm is clear as a circular or oval low-density shadow. Most of these patients are atypical, and it is easy to ignore clinically and cause hemorrhagic shock, causing serious consequences. Patients with rupture in the center should be closely observed, and the CT should be rechecked in time to observe whether the hematoma is enlarged. If hematoma is found in the abdominal cavity, surgery should be recommended. The CT of the subcapsular rupture is characterized by a characteristic crescent-shaped abnormal density area around the spleen, which is the case when bleeding is earlier, and gradually becomes low density after a long period of time, but the spleen is not special.
Splenectomy
- B-ultrasound and CT are now widely used imaging examinations, which are convenient and accurate in the diagnosis of abdominal parenchymal damage. B ultrasound makes a clear diagnosis through direct signs (spleen size, morphology, parenchymal echo, envelope continuity, peri-spleen echo, peritoneal effusion, etc.), or indirect signs (peritoneal effusion, peri-splenic effusion, enlarged spleen, etc.) ) Make an informative diagnosis of spleen injury. When there is no direct sign to confirm spleen rupture, the peritoneal effusion in the indirect sign should be given sufficient attention.
Splenectomy
- The technical characteristics of laparoscopic splenectomy (LS): traditional open splenectomy with large incisions and sufficient exposure. The operator can directly touch the resection with his hands. It is easy to break the spleen ligament and control bleeding, but There are obvious weaknesses such as large trauma and slow recovery. The laparoscopic free and resection of the spleen is significantly different from open surgery. Its technical characteristics are: First, the operator must have rich laparoscopic operation skills. Only with rich laparoscopic operation skills can the previous fixed thinking be changed and established The new sense of position and space of endoscope can master the skill of splenectomy under endoscope. The second is to control bleeding, which is the key to ensure the success of the operation. For normal-sized spleen, it is very easy to free the spleen ligament with the ultrasonic knife, and spleen is suspended after freeing the spleen ligament, and the spleen pedicle is directly separated with a linear closure, which is simple and safe. However, for patients with tortuous spleen hilum blood vessels, thick spleen blood vessels, and short spleen pedicles, it is easy to gradually separate the spleen hilum blood vessels, and the free splenic hilum blood vessels can be classified and selected when using clamps. The splenic hilar vessels are loose and can completely free the blood vessels, then clip with both ends of the tissue closure clip and cut off; if the blood vessels are tortuous with an ultrasonic knife or electrode hooks, and those who have difficulty in penetrating the blood vessels cannot be forced forcibly, which may cause blood vessels (especially It is a venous blood vessel) that tears and causes heavy bleeding. You can use a stepped clamp at both ends of the titanium clip with a length of 1.2cm, while clamping and cutting. This can ensure that the splenic portal blood vessels do not have uncontrollable bleeding due to excessive separation. When pulling the stomach, use the laparoscopic non-injury intestinal forceps to clamp and then pull to ensure that the stomach is not damaged by bleeding and bleeding. Using laparoscopic gastrointestinal fan leaf forceps to dial, lift, and press the spleen can make the spleen fully exposed without causing spleen bleeding. The third is to deal with the spleen as close to the spleen as possible to avoid pancreatic fistula due to damage to the tail of the pancreas when the spleen is cut by a straight cutting closure.