目的 探讨脾切除术后再出血的原因及诊治方法并总结其预防措施。方法 对我院1998年8月至2009年3月收治的11例脾切除术后再出血患者的临床资料进行回顾性分析。结果 本组11例再出血患者均行急诊再手术治疗，10例治愈,无术后并发症，恢复顺利，切口愈合良好，均拆线出院，术后住院10～21 d（平均15 d）； 余1例外伤性脾破裂者术中探查为胃短动脉破裂出血，遂结扎胃短动脉，术后发生胃瘘，经禁食、静脉营养等治疗，效果差，于术后20 d死亡。结论 脾切除术后再出血原因较多，以胃短血管处理不当、脾蒂血管结扎线脱落、胰尾部血管损伤及患者凝血功能障碍为主。脾切除术后出血以预防为主，术前充分做好各项准备，术中止血彻底，术后特别是术后24 h内严密观察腹腔引流液的量、性质及速度。再出血后果严重，一旦发生，应及时准确诊断，行急诊再手术治疗。
Objective To defect the level of platelet antibody-IgG (PA-IgG) in patients with congestive splenomegaly and hypersplenism and the change of PA-IgG level after splenectomy and subtotal splenectomy. Methods Twenty four cases of congestive splenomegaly and hypersplenism were investigated. Results The level of PA-IgG in 24 cases were higher than normal range (Ｐ＜0.01), while the platelet count were lower than normal range and there was a significant negative correlation between the level of PA-IgG and platelet count (r＝-0.4747, Ｐ＜0.05). After subtotal splenectomy or splenectomy, the level of PA-IgG descended, the platelet count raised and the negative correlation between the level of PA-IgG and platelet count disappeared. Conclusion The results suggest that there is a immunoregulation between PA-IgG and platelet. Perhaps spleen has some relation with the immunoregulation.