第四节　小儿脾脏的外科应用解剖

脾位于左季肋部,第9 和第11 肋间。 整个脾脏被腹膜包绕,由脾胃韧带、脾肾韧带和脾结肠韧带固定。 脾质软脆,色泽暗红、略呈椭圆形,可分为膈、脏两面,前后两缘和上、下两端。 脏面凹陷,近中央处为脾门,是神经、血管出入之处。 前缘较锐,下部有2～3 个切迹,称为脾切迹。

脾脏由腹腔动脉的最大分支脾动脉供血,该动脉自右向左走行于胰腺上缘,沿途分出若干小支入胰腺,然后经脾肾韧带间,接近脾门时分出胃短动脉和胃网膜左动脉。 在脾门分2～3 支主干进入脾脏,分为脾上叶、脾下叶2 支主干进入脾脏者,约占84%;余16%分为脾上、中、下叶三主干。 这些血管与脾脏长轴平行,每支叶动脉又分出与之垂直的 5～6 支小梁动脉,至脾外周成为终末小动脉。 脾静脉起于脾外周血窦,与动脉相伴,在动脉之后出脾,行经胰腺背面,到胰颈部与肠系膜上静脉汇合为门静脉。

脾脏的淋巴引流到脾门淋巴结。 15%～40%的人有副脾,数目不定。 多者5～6 个,常在脾门附近,也可在胰尾、脾韧带、网膜、小肠系膜,甚至在左侧卵巢或左侧睾丸内。

脾的表面有菲薄的纤维性被膜与腹膜相连,被膜的纤维组织深入脾内,形成一系列的小梁,是脾的支架。 小梁之间有脾髓。 脾实质分白髓和红髓两部分。 白髓即淋巴细胞围绕小动脉部分,由大量T 细胞和B 细胞组成。 红髓以网状内皮细胞为主,排列成细胞带,形成丰富的血窦。

小儿由于年龄不同,脾脏重量差异极大,各年龄儿童脾脏重量在10～113g 之间。 脾脏是最大的网状内皮细胞器官和淋巴器官。 脾包膜的纤维深入脾内,形成一系列小梁,小梁之间为脾髓。 脾实质分白髓和红髓两部分。 白髓即淋巴细胞围绕中央小动脉周围部分,多为T 淋巴细胞,为胸腺依赖区。 红髓在白髓周围,分为髓索及髓窦,是胸腺非依赖区,即B 淋巴细胞所在地之一。

(卢　云)

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