[Ligation of the splenic artery for traumatic rupture of the spleen--an experimental investigation].
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Background To report our experience of postoperative haemorrhage in patients following transoral robotic surgery ( TORS ). Methods Data were collected on patients having TORS . Postoperative haemorrhage within 30 days was graded using the Mayo Clinic grading system. Results Transoral robotic surgery operations were performed on 122 patients. There were 23 bleeding events classified as minor to severe following 19 operations (16%). Haemorrhage requiring a return to the operating room occurred after 7 operations (6%). The odds of an emergent haemorrhage were 5.19 times greater in patients who had a staged neck dissection after TORS ( P = .05). The odds of a postoperative bleeding event were 2.6 times greater in patients receiving a larger resection ( P = .107). There were no haemorrhage events in the 36 patients who received a synchronous neck dissection with transcervical ligation of the external carotid artery. Conclusions Surgical intervention for TORS haemorrhage occurred in 6% patients. No haemorrhage occurred in patients who had ligation of the external carotid artery.
Transoral robotic surgery
Neck dissection
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Reports on postsplenectomy septicemia have led to a more conservative attitude to treatment of splenic trauma. A case of traumatic rupture of the spleen treated with splenic artery ligation is presented. In the 5-year follow-up the investigations included repeated scintigraphy. Alternative management of traumatized spleen is discussed.
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Blood supply
Collateral circulation
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The authors report 6 cases of life threatening hemorrhage which occurred in 1985-1995. The cases were characterized by massive recurrent bleeding resistant to standard conservative methods of stopping. In a posttonsillectomy patient bleeding from the tonsillar niche and in two patients nasal bleeding because of trauma or tumor were stopped only after ligation of the external carotid artery. Arrosive bleeding from the internal jugular vein in a patient after opening of a deep tonsillogenic neck flegmon was stopped by ligation of the jugular vein along the length of the wound. Bleeding after opening of a paratonsillar abscess was stopped after abscess tonsillectomy. Bleeding from tracheostoma was stopped only after suturing of the vessel in the wound. All the 6 patients were discharged in a satisfactory condition.
Internal jugular vein
Peritonsillar Abscess
External jugular vein
Jugular vein
Neck dissection
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Objective To explore the feasibility and safety of the spleen-preserving surgery in the treatment of traumatic rupture.Methods 47 patients with traumatic rupture were treated with spleen-preserving surgery:the biological glue which local physical bleeding had 7 cases,suture repair had 13 cases,splenic artery ligation had 10 cases,splenic artery ligation and splenic repair had 9 cases,partial splenectomy had 8 cases.Results 47 patients had four cases of infection,and cured after dressing,1 case had postoperative bleeding symptoms and used splenectomy surgery.46 patients with spleen-preserving operation is successful,the average length of stay was 15 days,there is no deaths.After 6 months,all patients used abdominal B-utrasoundor CT scans to confirm the survival of spleen is good and indicator of the examination is normal.Follow-up of these patients had no dangerous infections and complications.Conclusion Spleen-preserving surgery in the treatment of traumatic rupture was safe,feasible,could retain the greatest degree of function,and could be used in clinical practice.
Key words:
Splenic rupture; Spleen-preservation; Treatment outcome
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[Objective]To discuss the treatment of traumatic splenic rupture with spleen-preserving operation in situ.[Methods]48 of 76 patients with traumatic splenic rupture were treated with spleen-preserving operation.[Results]In 48 patients of spleen-preserving operation in situ,36 cases of grade Ⅲ,Ⅳ splenic rupture were conducted with splenic artery ligation and irregular partial splenectomy,all cured and no complications.[Conclusion]Spleen-preserving operation in situ makes spleen function recover quickly,has few complications.In some conditions,splenic artery ligation and irregular partial splenectomy should be preferred in treating splenic rupture(grade Ⅲ or Ⅳ),which would get better clinical effects.
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Splenic disease
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