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中华危重症医学杂志(电子版) ›› 2024, Vol. 17 ›› Issue (03) : 251 -253. doi: 10.3877/cma.j.issn.1674-6880.2024.03.013

病例报告

结肠镜检查术后脾破裂一例并文献复习
吴昕1, 顾青1, 郑丛如1, 金梦1, 徐承富1,()   
  1. 1. 310003 杭州,浙江大学医学院附属第一医院消化内镜中心
  • 收稿日期:2024-01-17 出版日期:2024-06-30
  • 通信作者: 徐承富
  • Received:2024-01-17 Published:2024-06-30
引用本文:

吴昕, 顾青, 郑丛如, 金梦, 徐承富. 结肠镜检查术后脾破裂一例并文献复习[J]. 中华危重症医学杂志(电子版), 2024, 17(03): 251-253.

结肠镜检查术后脾破裂是一种罕见并发症,病死率高,需要立即诊断和管理。据报道结肠镜检查中脾破裂的发病率为0.000 05% ~ 0.017 00%,病死率为5%,损伤机制可能与直接创伤或脾结肠韧带过度牵拉有关[1-2]。脾破裂的治疗方法包括保守治疗、脾动脉栓塞术(splenic artery embolization,SAE)、脾切除术等,其中急诊脾切除术是目前临床上最常见的治疗选择[3]。但在患者病情稳定且条件允许的情况下,应当充分考虑保留患者的脾功能。有研究报道107例动脉损伤患者的栓塞治疗成功率为82.2%;脾动脉分支可进一步向近端脾动脉栓塞或更多远端选择性栓塞的方向发展[4]。SAE治疗结肠镜检查术后并发脾破裂目前并未得到广泛应用,浙江大学医学院附属第一医院消化内科采用SAE成功救治一例结肠镜检查术后并发脾破裂的患者,现报道如下。

图1 结肠镜检查术后并发脾破裂患者CT图注:a图为增强CT,显示脾脏前缘有造影剂外渗,提示有活动性出血的可能;b图为后续CT扫描,显示出血部位有明显的吸收
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