CLINICAL ANATOMY OF THE SPLEEN AS A BASIS FOR ORGAN-PRESERVING OPERATIONS

The purpose of the study is to obtain new relevant information about the macromicroanatomy and topography of the spleen in normal conditions and to create an anatomical basis for the development of organ-preserving operations using microsurgical techniques.Material and methods. In the course of the study, intravital computed tomographic anatomy of the spleen was studied. Computed tomograms of the abdominal cavity and retroperitoneal space were chosen as the basis for the analysis, with the level of imagecapture from the diaphragm to the ischial bones. The study involved 110 patients who had no pathology of the abdominal cavity andretroperitoneal space. The age of the patients ranged from 22 to 87 years. There were 66 (60%) female and 44 (40%) male patients. The macromicroanatomy of the upper and lower poles of the spleen was also studied based on the analysis of 10 histotopographic sections of the poles of human cadaveric spleens in the sagittal projection.Results. It was revealed that the most common localization of the upper pole of the human spleen is the projection level of the XI thoracic vertebra, and the lower pole of the spleen is on the level of the I lumbar vertebra. The most common variant of the location of the spleen in humans was the one in which it was localized from the projection level of the XI thoracic vertebra to the II lumbar vertebra.According to the present study, based on the diameter of the intraorgan splenic vessels, the spleen pole can be divided into 3 zones, i.e. the spleen capsule with a thickness of 0.2 ± 0.05 mm, the superficial zone 1.5 - 2.0 cm deep from the surface of the organ with a diameter vessels up to 0.5 mm inclusive, and a deep zone in which vessels with the diameter of 0.6 mm and more pass.Conclusions. The skeletotopy of the spleen was studied by computed tomography, on the basis of which the most optimal vari-ant of operational access to this organ was proposed, which consists in performing an oblique left-sided hypochondral laparotomy, from the level of the 6th intercostal space to the level of the 8-9th intercostal space on the left.The use of a microsurgical suture material for the human spleen is substantiated. The division of the spleen pole into zones isproposed, which is necessary for the choice of surgical tactics when performing organ-preserving interventions.

spleen, computed tomography, macromicroanatomy, organ-preserving operations