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上海交通大学医学院附属瑞金医院普外科
Splenic Anatomy
Structure of the
sinusoidal spleen shows
the open and closed
blood flow routes
Splenic function
• mechanical filtration:
Biologic Substances Removed by the Spleen
*
In Normal Subjects
Red blood cell membrane
Red blood cell surface pits and craters
Howell-Jolly bodies
Heinz bodies
Pappenheimer bodies
Acanthocytes
Senescent red blood cells
Particulate antigen
In patients with disease
Spherocytes (hereditary
spherocytosis)
Sickle cells, hemoglobin C
cells
Antibody-coated red blood
cells
Antibody-coated platelets
Antibody-coated white
blood cells
SPLENECTOMY FOR BENIGN
HEMATOLOGIC CONDITIONS
• Immune Thrombocytopenic Purpura
• Hereditary Spherocytosis
• Hemolytic Anemia due to Erythrocyte Enzyme
Deficiency
• Hemoglobinopathies
SPLENECTOMY FOR
MALIGNANCY
• Lymphomas:
- Hodgkin’s Disease
- Non-Hodgkin’s Lymphomas
• Leukemia:
- Hairy Cell Leukemia
- Chronic Lymphocytic Leukemia
- Chronic Myelogenous Leukemia
• Nonhematologic Tumors of the Spleen
SPLENECTOMY FOR MISCELLANEOUS
BENIGN CONDITIONS
• Splenic Cysts
• Splenic Abscess
• Wandering Spleen
SPLENIC TRAUMA
•
-
Diagnosis
History
Physical examinations
DPL (Diagnostic peritoneal lavage)
CT
Ultrasonography
Indication for exploration
•
hemodynamic instability
- no standard criteria for hemodynamic instability
- a general guideline ：
1.systolic blood pressure ﹤ 90 mm Hg/
a pulse ﹥120 beats/min if there is not
immediate
response to 1 to 2 L of crystalloid resuscitation
2. when physical examination, ultrasound, or
DPL indicates intra-abdominal blood loss
ELECTIVE LAPAROSCOPIC
SPLENECTOMY
• Strict lateral position of the
patient for laparoscopic
splenectomy. The table is
angulated, giving forced lateral
flexion of the patient to open
the costophrenic space.
• Trocars are inserted along the
left costal margin more
posteriorly. The spleen is
hanged by its peritoneal
attachments. The numbered
lines show the position of
laparoscopic ports.
Usual location of accessory spleens:
(1) gastrosplenic ligament,
(2) splenic hilum,
(3) tail of the pancreas,
(4) splenocolic ligament,
(5) left transverse mesocolon,
(6)greater omentum along the
greater curvature of the stomach,
(7) mesentery,
(8) left mesocolon,
(9) left ovary,
(10) Douglas pouch,
(11) left testis