Incision selection Commonly used incisions for splenectomy are: left upper abdominal transseptal incision, median incision, left subcostal incision, left upper abdominal “L” incision, and transverse upper abdominal incision. No matter what kind of preoperative tests you use and how you determine splenic rupture, the incision should still be made in a way that facilitates both the removal of the spleen and the exploration and treatment of other abdominal organs! Therefore, an exploratory left upper abdominal incision is recommended, and if intraoperative rupture of the liver is found to be combined, only a T-shaped incision is made via a central extension of the incision to the right. Although a transverse incision can meet the requirements, it is mainly used in children and in practice, it is very uncomfortable! Spleen exploration Immediately after opening the abdomen and aspirating some of the accumulated blood, a spleen exploration is performed. The diaphragmatic surface of the spleen and the posterior lateral margin of the spleen are explored first, and then a dry gauze pad is filled in behind the posterior lateral margin of the spleen to bring the spleen into the field of view. The splenic surface and upper and lower poles are explored under direct vision. If there is no abnormality the splenic hilum needs to be explored by incising the gastrocolic ligament. If a blood clot is found in the splenic fissure during the exploration, do not remove it to prevent hemorrhage. If no obvious cleft is found in the spleen, other organs should be explored immediately. Splenectomy If the bleeding from the spleen has stopped or is moderate, the splenogastric ligament, gastric omental vessels, short gastric vessels, splenorenal ligament, and splenorenal ligament can be severed by ligating the spleen in order and holding it out and then severing the splenic hilar vessels under direct vision. If the spleen is still bleeding with violent activity, the splenic portal vessels should be blocked immediately and the spleen should be removed. The specific requirements are: free the splenorenal ligament and block the splenic hilum within 1 minute, and remove the spleen within 3 minutes. (This is what we often say: the more serious the splenic laceration, the faster the splenectomy.) Specific operation: The first four fingers of the operator’s left hand bluntly separate the splenorenal ligament from the outside to the inside (actually tearing the splenic peritoneum connected with the splenorenal ligament), turn the spleen inward and upward, pinch the splenic hilar vessels with the left thumb and forefinger in line, separate the gap above the splenic hilar vessels with a vascular clamp, then double clamp the splenic artery near the splenic hilar and cut the splenic hilum. Then the spleen is pulled downward out of the incision, and the short gastric vessels are ligated and cut under direct vision, and the spleen is removed. Complete hemostasis After removal of the spleen, do not rush to ligate the splenic hilum first; the bleeding has stopped at this point, and it is necessary to move immediately from a ferocious resection state to a gentle and meticulous hemostasis state. You should first push down on the colon, pull the gastric body internally, flush the wound, fill the splenic fossa with dry pads, and then lift the splenictip forceps to carefully seem. Note that these two splenictip clamps were lying under the incision by themselves from the time they were clamped on until now, I had no room to hold him up, and others had better not move either! It will not tear the splenic vessels by itself! As close to the splenic portal clamp, at this time the clamp should be some distance from the pancreas, if a little far, the proximal end and then on a hand, the ligature point from the pancreas half a centimeter is good, too long easy to form thrombophlebitis, also not good. Then double ligature plus suture ligation, artery and then add a, rest assured! Then explore the greater curvature of the stomach, there is a vascular tear must be stitched. Finally, look at the splenodiaphragm and splenorenal ligament. Stop the bleeding from superficial to deep and do not affect each other.