D L Liu1, S Xia, W Xu, Q Ye, Y Gao, J Qian. 1. Department of Surgery, Tongji Hospital, Tongji Medical University, Wuhan, China.
Abstract
BACKGROUND: Anatomic knowledge of vasculature of the splenic lobe and segment is of great clinical significance in partial resections and transplantation of the spleen. METHODS: The methods of two-colored corrosion casting, roentgenography, and anatomic dissection were used to evaluate the vasculature of the splenic hilum and intraspleen. On this basis splenic lobectomy and segmentectomy were performed on 42 patients with traumatized spleens. RESULTS: In the observation of 850 spleen specimens the spleen showed a single lobar artery in 7 cases (0.8%), two lobar arteries in 730 cases (86%), three lobar arteries in 104 cases (12.2%), and multiple lobar arteries (i.e., more than three lobar arteries) in 9 cases (1%). In a subgroup of 276 specimens 17%, 53%, 24%, 4%, 1%, and 1% of spleen specimens had three, four, five, six, seven, and eight segmental arteries, respectively. The result from a subgroup of 280 specimens indicated that mean percentages of the existence of the superior and inferior polar arteries and of the coexistence of both polar arteries were 31.3%, 38.8%, and 13.3%, respectively. Relative avascular planes between segments or lobes were seen. Basic steps of splenic lobectomy or segmentectomy include mobilization of the injured spleen, ligation of vessels in the lobe or segment, transection of the splenic parenchyma, and sutures of the cut surface of the remaining spleen. The postoperative courses of all 42 patients undergoing partial splenectomy were uneventful. No postoperative bleeding and necrosis of the remaining spleen or infectious complications were registered. CONCLUSIONS: Anatomically the spleen is defined with two primary lobes (the superior lobe and inferior lobe), one accessory lobe, and three to five segments. This new classification facilitates surgeons to perform partial resections of the spleen and allotransplantation of the hemispleen from a living related donor in human beings.
BACKGROUND: Anatomic knowledge of vasculature of the splenic lobe and segment is of great clinical significance in partial resections and transplantation of the spleen. METHODS: The methods of two-colored corrosion casting, roentgenography, and anatomic dissection were used to evaluate the vasculature of the splenic hilum and intraspleen. On this basis splenic lobectomy and segmentectomy were performed on 42 patients with traumatized spleens. RESULTS: In the observation of 850 spleen specimens the spleen showed a single lobar artery in 7 cases (0.8%), two lobar arteries in 730 cases (86%), three lobar arteries in 104 cases (12.2%), and multiple lobar arteries (i.e., more than three lobar arteries) in 9 cases (1%). In a subgroup of 276 specimens 17%, 53%, 24%, 4%, 1%, and 1% of spleen specimens had three, four, five, six, seven, and eight segmental arteries, respectively. The result from a subgroup of 280 specimens indicated that mean percentages of the existence of the superior and inferior polar arteries and of the coexistence of both polar arteries were 31.3%, 38.8%, and 13.3%, respectively. Relative avascular planes between segments or lobes were seen. Basic steps of splenic lobectomy or segmentectomy include mobilization of the injured spleen, ligation of vessels in the lobe or segment, transection of the splenic parenchyma, and sutures of the cut surface of the remaining spleen. The postoperative courses of all 42 patients undergoing partial splenectomy were uneventful. No postoperative bleeding and necrosis of the remaining spleen or infectious complications were registered. CONCLUSIONS: Anatomically the spleen is defined with two primary lobes (the superior lobe and inferior lobe), one accessory lobe, and three to five segments. This new classification facilitates surgeons to perform partial resections of the spleen and allotransplantation of the hemispleen from a living related donor in human beings.