indicatiile splenectomiei
TRANSCRIPT
![Page 1: INDICATIILE SPLENECTOMIEI](https://reader033.vdocuments.net/reader033/viewer/2022052210/5571fb304979599169942ef0/html5/thumbnails/1.jpg)
INDICATIILE SPLENECTOMIEI
![Page 2: INDICATIILE SPLENECTOMIEI](https://reader033.vdocuments.net/reader033/viewer/2022052210/5571fb304979599169942ef0/html5/thumbnails/2.jpg)
OBIECTIVELE CURSULUI
1) Stabilirea indicatiilor terapeutice, diagnostice si tactice ale splenectomiei
2) Indicatiile splenectomiei laparoscopice
3) Indicatiile splenectomiei partiale
![Page 3: INDICATIILE SPLENECTOMIEI](https://reader033.vdocuments.net/reader033/viewer/2022052210/5571fb304979599169942ef0/html5/thumbnails/3.jpg)
Structura cursului
1) Definitia splenectomiei
2) Splenectomia terapeutica absoluta si relativa
3) Splenectomia diagnostica
4) Splenectomia tactica
5) Splenectomia laparoscopica
6) Splenectomia partiala
![Page 4: INDICATIILE SPLENECTOMIEI](https://reader033.vdocuments.net/reader033/viewer/2022052210/5571fb304979599169942ef0/html5/thumbnails/4.jpg)
Definitia splenectomiei
= ablatia totala a tesutului splenic ( splina + splinele accesorii)
Modificarile morfologice si functionale +contextul patologic -> indicatia splenectomiei
![Page 5: INDICATIILE SPLENECTOMIEI](https://reader033.vdocuments.net/reader033/viewer/2022052210/5571fb304979599169942ef0/html5/thumbnails/5.jpg)
Splenectomia terapeutica
1) Hemoragiile splenice1.1 Traumatisme nereparabileClasificarea rupturilor splenice (AAST Organ Injury Scale):
Grad I
Hematom subcapsular <10% din suprafata
Lacerare, ruptura capsulara < 1 cm profunzime parenchim
![Page 6: INDICATIILE SPLENECTOMIEI](https://reader033.vdocuments.net/reader033/viewer/2022052210/5571fb304979599169942ef0/html5/thumbnails/6.jpg)
Grad II hematom subcapsular 10-50% din suprafata sau
intraparenchimatos <5 cm diametru Lacerare 1-3 cm profunzime fara implicarea vaselor
parenchimatoase
![Page 7: INDICATIILE SPLENECTOMIEI](https://reader033.vdocuments.net/reader033/viewer/2022052210/5571fb304979599169942ef0/html5/thumbnails/7.jpg)
Grad III Hematom subcapsular >50% suprafata sau
hematom intraparenchimatos >5cm diametru Lacerare >3cm parenchim sau implicarea vaselor
trabeculare
![Page 8: INDICATIILE SPLENECTOMIEI](https://reader033.vdocuments.net/reader033/viewer/2022052210/5571fb304979599169942ef0/html5/thumbnails/8.jpg)
Grad IV lacerare a vaselor segmentare sau hilare producand devascularizare majora (>25%)
![Page 9: INDICATIILE SPLENECTOMIEI](https://reader033.vdocuments.net/reader033/viewer/2022052210/5571fb304979599169942ef0/html5/thumbnails/9.jpg)
Grad V ruptura completa a splinei
![Page 10: INDICATIILE SPLENECTOMIEI](https://reader033.vdocuments.net/reader033/viewer/2022052210/5571fb304979599169942ef0/html5/thumbnails/10.jpg)
Splenectomia terapeutica
1.2 Ruptura anevrismelor vaselor splenice in hil:
a)etiologie: ATS, degenerescenta mediei, traumatisme etc.
b)debut: hemoragie perianevrismal sau in bursa omentala
c)complicatie: infarct splenic prin microemboli din punga anevrismala
![Page 11: INDICATIILE SPLENECTOMIEI](https://reader033.vdocuments.net/reader033/viewer/2022052210/5571fb304979599169942ef0/html5/thumbnails/11.jpg)
Splenectomia terapeutica
![Page 12: INDICATIILE SPLENECTOMIEI](https://reader033.vdocuments.net/reader033/viewer/2022052210/5571fb304979599169942ef0/html5/thumbnails/12.jpg)
Splenectomia terapeutica
1.3 Ruptura varicelor gastrice si/sau esofagiene din obstructiile venei splenice
a)etiologie: pancreatite, pseudochisturi, tumori , micoze, tu. retroperitoneale, traumatisme, anomaliile venei splenice
b)fiziopat.: HTP in teritoriul v. splenice =>varice g-e
c) Dg. clinic: splenomegalie, varice gastroesofagiene, ficat normal
d)Paraclinic: ecografie, angiografie selectiva celiaca, splenoportografie, endoscopie digestiva superioara
![Page 13: INDICATIILE SPLENECTOMIEI](https://reader033.vdocuments.net/reader033/viewer/2022052210/5571fb304979599169942ef0/html5/thumbnails/13.jpg)
Splenectomia terapeutica
2) Hipersplenismul sever =sindrom care asociaza splenomegalia + mono, bi, sau
pancitopenia sangvina periferica+ hiperactivitatea maduvei osoase
-cu distructie predominant splenica
-refractar la terapia de imunosupresie
-in hipertensiunea portala
-persistent dupa efectuarea suntului portocav (15%)
![Page 14: INDICATIILE SPLENECTOMIEI](https://reader033.vdocuments.net/reader033/viewer/2022052210/5571fb304979599169942ef0/html5/thumbnails/14.jpg)
Splenectomia terapeuticaHipersplenismul
Primar1)Purpura trombocitopenica imuna
(b. Werlhoff)2)Anemii hemolitice congenitale3)Anemia hemolitica imuna
idiopatica4)Neutropenia splenica primara5)Pancitopenia splenica primara
Secundar1)Hipertensiune portala2)Boli parazitare (malarie, kala-
azar)3)Infectii bacteriene cronice (tbc,
lues)4)Limfoame5)Leucemii cronice6)Artrita reumatoida (sdr. Felty)7)Lupus eritematos sistemic8)Tezaurismoze (b. Gaucher etc)9)Limfo si reticulosarcoame
![Page 15: INDICATIILE SPLENECTOMIEI](https://reader033.vdocuments.net/reader033/viewer/2022052210/5571fb304979599169942ef0/html5/thumbnails/15.jpg)
Splenectomia terapeutica
3) Leziunile tumorale splenice
A)chisturi :
a)parazitare (chistul hidatic)
b)neparazitare: primare(congenitale, neoplazice) si secundare (posttraumatice, degenerative,inflamatorii- abcese)
![Page 16: INDICATIILE SPLENECTOMIEI](https://reader033.vdocuments.net/reader033/viewer/2022052210/5571fb304979599169942ef0/html5/thumbnails/16.jpg)
Splenectomia terapeutica
B)tumori:
a)benigne (disembrioplazii, vasculare, alte tumori- lipom, fibrom)
b)maligne (vasculare-hemangiosarcom, pulpa alba- limfosarcom, pulpa rosie- reticulosarcom, alte tumori- teratom malign)
![Page 17: INDICATIILE SPLENECTOMIEI](https://reader033.vdocuments.net/reader033/viewer/2022052210/5571fb304979599169942ef0/html5/thumbnails/17.jpg)
Splenectomia terapeutica
4) Infarctele splenice
-persistenta durerilor, complicatii (infectii primare sau secundare, pseudochisturi)
a)etiologie: embolism, blocarea circulatiei splenice in boli sistemice (anemia falcipara, leucemia mieloida cronica etc)
b)clinic: dureri hipoc. Stg., greturi, varsaturi, splenomegalie dureroasa
c)paraclinic: ecografie, CT (arie hipodensa), angiografie (arie avasculara)
![Page 18: INDICATIILE SPLENECTOMIEI](https://reader033.vdocuments.net/reader033/viewer/2022052210/5571fb304979599169942ef0/html5/thumbnails/18.jpg)
Splenectomia terapeutica
5) Infectiile splenice (abcese, infectii cronice)
6) Splenomegalia giganta cu sindroame de compresiune pe tubul digestiv (disconfort, ocluzii intestinale)
![Page 19: INDICATIILE SPLENECTOMIEI](https://reader033.vdocuments.net/reader033/viewer/2022052210/5571fb304979599169942ef0/html5/thumbnails/19.jpg)
Splenectomia terapeuticaIndicatii absolute
Vitale1)Traumatisme splenice2)Abces splenic cu
sindrom septic3)Anevrisme rupte4)Infarct splenic5)Ocluzie intestinala6)Tromboza venei
splenice cu varice gastrice rupte
Elective1)Sferocitoza ereditara2)PTI3)Chistul hidatic splenic4)Tumori splenice benigne
sau maligne
![Page 20: INDICATIILE SPLENECTOMIEI](https://reader033.vdocuments.net/reader033/viewer/2022052210/5571fb304979599169942ef0/html5/thumbnails/20.jpg)
Splenectomia terapeuticaIndicatii relative
Anemia hemolitica autoimuna
Neutropenia splenica Sindromul Felty Metaplazia mieloida Boala Gaucher Anevrisme necomplicate Tumori splenice
metastatice
-alternative:
1)Splenectomie laparoscopica
2)Splenectomie partiala
3)Chirurgie vasculara
![Page 21: INDICATIILE SPLENECTOMIEI](https://reader033.vdocuments.net/reader033/viewer/2022052210/5571fb304979599169942ef0/html5/thumbnails/21.jpg)
Splenectomia terapeutica
Cea mai frecventa indicatie= traumatismul splenic nereparabil
![Page 22: INDICATIILE SPLENECTOMIEI](https://reader033.vdocuments.net/reader033/viewer/2022052210/5571fb304979599169942ef0/html5/thumbnails/22.jpg)
Splenectomia diagnosticaIndicatii
1)Tumori splenice de etiologie neprecizata
2)Limfoame Hodgkin (stadiul Ia, IIb)
3)Limfoame non-Hodgkin
Reducerea indicatiilor datorita laparoscopiei diagnostice
![Page 23: INDICATIILE SPLENECTOMIEI](https://reader033.vdocuments.net/reader033/viewer/2022052210/5571fb304979599169942ef0/html5/thumbnails/23.jpg)
Splenectomia tactica
=necesara in cursul unor interventii chirurgicale
De evitat- influenteaza negativ morbiditatea postoperatorie
Indicatii:
1)pancreatectomie (totala, stanga)
2)gastrectomie totala
3)sunt spleno-renal (fig)
![Page 24: INDICATIILE SPLENECTOMIEI](https://reader033.vdocuments.net/reader033/viewer/2022052210/5571fb304979599169942ef0/html5/thumbnails/24.jpg)
Splenectomia tactica
4)Esofagoplastie
(D. Gavriliu)(tub gastric din marea curbura)(fig.)
5)Hemicolectomie stanga
6)Nefrectomie stanga
![Page 25: INDICATIILE SPLENECTOMIEI](https://reader033.vdocuments.net/reader033/viewer/2022052210/5571fb304979599169942ef0/html5/thumbnails/25.jpg)
Indicatiile splenectomiei laparoscopice
Splenectomia clasica1)traumatisme splenice
severe2)tumori maligne ale
splinei3)splenomegalii mari
(>20cm)4)abcese splenice
Splenectomia laparoscopica
1)trombocitopenia imuna2)anemii hemolitice3)chisturi neparazitare4)tumori splenice benigne5)limfom Hodgkin (pentru
stadializare)
![Page 26: INDICATIILE SPLENECTOMIEI](https://reader033.vdocuments.net/reader033/viewer/2022052210/5571fb304979599169942ef0/html5/thumbnails/26.jpg)
Splenectomia partiala
Procedeu curent datorita cunoasterii segmentatiei splinei si progreselor in tehnica chirurgicala (adezivi hemostatici- surgicel, tahocom, stapler)
Preferata la copii si adultii tineri Se evita complicatiile postsplenectomie
(infectii recurente- pneumococ, h. influenze, gonococ)
![Page 27: INDICATIILE SPLENECTOMIEI](https://reader033.vdocuments.net/reader033/viewer/2022052210/5571fb304979599169942ef0/html5/thumbnails/27.jpg)
Splenectomia partialaIndicatii
1)Hemostaza: traumatisme cu devitalizare partiala
2)Ablatia leziunilor splenice localizate: chisturi neparazitare, pseudochist, chist hidatic, tumori solide benigne, infarcte polare, abces polar
3)Reducerea volumului splenic: boala Gaucher (copii), hipersplenism sever (copii), mielofibroza, schizostomiaza
4)Diagnostice: limfom Hodgkin, tumori de cauza neprecizata, splenomegalii izolate
![Page 28: INDICATIILE SPLENECTOMIEI](https://reader033.vdocuments.net/reader033/viewer/2022052210/5571fb304979599169942ef0/html5/thumbnails/28.jpg)
Bibliografie
N. Angelescu: Tratat de patologie chirurgicala, Editura Medicala, 2001
Schwartz: Principles of Surgery, Mc Graw Hill,1999
Greenfield: Surgery: Principles , Practices and Techniques, Lippincott- Rover Publisher, 1998
Site web: http://www.trauma.org