A Study On Laparoscopic Surgery For Preserving Ruptured Spleen

[Objective]To explore the indications,methods and effects of laparoscopic for preserving ruptured spleen.[Methods]Ninty-four patients with traumatic splenic rupture were treated in Peking university Shenzhen hospital between January 2003 and December 2009. Among them,we conducted laparoscopic surgery for 11 cases. According to the classification of splenic injury,3 cases were classified as"typeⅠ",4 cases as"typeⅡ",2 cases as "typeⅢ"and 2 cases as "type IV".11 patients were treated by laparoscopic approach and were intended to spare splenic tissue as much as possible According to the different injuries. The Changes of the serum immunoglobulin such as IgG, IgM and IgA were observed.2 cases treated by laparoscopic splenectomy with splenic autotransplantation under liver capsular were done on 99MTc-PHT spleen images.[Results]Laparoscopic spleen-preserving were performed in 9 cases ("type I "to"typeⅢ"). Among them,3 cases used the gum to stick the wound of the splenic rupture or used electrocoagulation. 2 cases sewed up to repair the wound of the splenic rupture.2 cases used gastrocolic omentum to packing add to repair the wound of the splenic rupture.1 case underwent part excision of spleen.1 case ligated the spleen artery add to repair the wound of the splenic rupture. 3-ultrasound and CT-scanning were used at 3 months after operation, the result showed successful operations were achieved. IgG of the serum immunoglobulin was 14.6±5.3,IgA was 2.72±1.47,IgM was 2.28±1.04 3 months after operation. Laparoscopic splenectomy with splenic autotransplantation under liver capsular were performed in 2 cases ("type IV") 99MTc-PHT spleen imaging 3 months after operation showed its survival. IgG of the serum immunoglobulin was 10.3±1.72,IgA was 2.47±1.0,IgM was 1.96±0.94.[Conclusion]Laparoscopic Surgery for preserving ruptured spleen is feasible for"typeⅠ,ⅡorⅢ"ruptured spleen without severe complicating injuries. Laparoscopic splenectomy with splenic autotransplantation under liver capsular is feasible for "type IV"ruptured spleen without severe shock. As long as indications are seized, the laparoscopic Surgery for preserving the function of ruptured spleen is feasible with the advatanges of good curative effect, minimal invasion and quick recovery.