splenectomy

Splenic resection is widely used in spleen trauma, local infection of the spleen, benign (such as hemangioma) or malignant (such as lymphosarcoma) tumors, cysts, gastric cancer, intrahepatic portal hypertension and hypersplenism. Treatment of diseases: traumatic spleen rupture spleen rupture Indication 1. Traumatic spleen rupture. 2. Hypersplenism caused by various reasons. 3. Idiopathic thrombocytopenic purpura. 4. Hereditary spherocytosis. 5. Spleen cysts. 6. Spleen tumors. 7. Additional surgery for radical gastrectomy. 8. Chronic lymphocyte and granulocyte leukemia. 9. Staged laparotomy for Hodgkin's disease. Contraindications Splenectomy should not be performed in children under the age of 15 or in patients with hemolytic crisis. Preoperative preparation 1. Emergency surgery: When emergency surgery is required when the spleen ruptures, hemorrhagic shock should be prevented at the same time as preoperative preparation, so that the operation can be performed in the shortest time. Patients with severe spleen rupture, due to a large number of internal hemorrhage, often accompanied by hemorrhagic shock, need a large number of rapid blood transfusion, if necessary, arterial pressure transfusion, and adequate blood preparation. At the same time, attention should be paid to the multiple injuries of other organs and given treatment. Gastrointestinal decompression should be performed before surgery to prevent the stomach from expanding and hindering the exposure. Sufficient antibiotics should also be given to prevent infection. When the preoperative preparation is basically completed and the surgical instruments are ready, the operation should be stopped as soon as possible under anti-shock treatment, and should not wait for shock to correct. 2. Selective surgery: Chronic spleen diseases other than rupture should be elective surgery. Pay attention to improve the general condition, a small amount of blood transfusion, protect liver function, correct coagulation insufficiency, and perform necessary laboratory tests (including hemoglobin measurement, red blood cell count, total white blood cell count and classification, platelet count, vascular fragility test, bleeding time, clotting time, Prothrombin time, etc.). Gastrointestinal decompression should be performed before operation. For patients with esophageal varices, soft stomach tube should be selected. A small amount of liquid paraffin should be taken before the lower tube. Pay special attention to prevent major bleeding. Blood should be prepared before surgery to prepare for blood transfusion. Sufficient antibiotics should also be given. Surgical procedure 1 When selecting the position of the incision, the patient's condition, body shape and other factors should be fully considered to ensure that the incision can be fully exposed; 2 pay attention to protect adjacent organs, fully free, cut off the spleen ligament and undergo splenectomy; 3 Do not use brute force when pulling and lifting the spleen, so as not to cause massive bleeding caused by tearing the spleen; 4 pre-ligature the splenic artery to reduce spleen congestion, reduce spleen volume and reduce bleeding.

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