射频消融在脾破裂修补术中的应用  

Application of radiofrequency ablation in repair of splenic rupture

作　　者：胡可俊[1] 陈飞[1] 张腾飞[1] 安东[1] HU Ke-jun;ChHEN Fei;ZHANG Teng-fei(Department of Hepatobiliary Surgery,Chaohu Hospital,Anhui Medical University,Hefei,Anhui 238001,China)

机构地区：[1]安徽医科大学附属巢湖医院肝胆外科,合肥238001

出　　处：《肝胆外科杂志》2020年第3期224-227,共4页Journal of Hepatobiliary Surgery

摘　　要：目的探究射频消融辅助的脾修补术在创伤性破裂脾脏患者中应用的临床价值。方法回顾我院2015年4月至2018年11月收治创伤性脾破裂患者(48例)病史资料,依照手术方式不同分为射频消融辅助下脾修补组(射频修补组14例)和脾切除组(切除组34例)。对两组患者术中、术后相关指标差异以及术前、术后第1天及第5天白细胞和血小板计数变化进行比较分析。结果射频修补组和切除组比较结果:手术时间(min)(127.86±36.78 vs 91.38±36.15,P<0.05)、住院费用(万)(3.5±0.9 vs 2.6±1.1,P<0.05),术后72h腹腔引流总量(ml)(180.0±171.6 vs 301.2±161.7,P<0.05),腹腔引流管留管时间(d)(5.4±1.8 vs 7.4±2.5,P<0.05),禁食时间(d)(3.0±0.96 vs 4.0±1.37,P<0.05),住院时间(d)(12.14±7.13 vs 21.44±9.06,P<0.05);射频修补组较切除组术后手术创伤应激小且无继发血小板增高。两组术中输血率,术后并发症:发热、胸积液、切口裂开、下肢静脉血栓形成发生率均无差异(P>0.05)。结论在生命体征稳定的Ⅰ、Ⅱ、Ⅲ级脾损伤患者中行射频消融辅助脾修补术安全、可行。Objective To explore the clinical value of radiofrequency ablation(RFA)assisted spleen repairing surgery in patients with traumatic rupture of spleen.Methods Review the medical history of patients with traumatic splenic rupture(48 cases)admitted to our hospital from April 2015 to November 2018,and cases were divided into radiofrequency ablation assisted splenic repair group(RFA group n=14)and splenectomy group(resection group n=34)according to different surgical methods.Then analysis the differences in relevant indexes between the two groups of patients during the perioperative periods,including the changes in white blood cell and platelet counts before and after operation on day 1 and day 5.Results Comparison results between RFA group and resection group:operation time(min)(127.86±36.78 vs 91.38±36.15,P<0.05),hospitalization cost(ten thousand)(3.5±0.9 vs 2.6±1.1,P<0.05),operation After 72 h,total abdominal drainage(ml)(180.0±171.6 vs 301.2±161.7,P<0.05),retention time of abdominal drainage tube(d)(5.4±1.8 vs 7.4±2.5,P<0.05),fasting time(d)(3.0±0.96 vs 4.0±1.37,P<0.05),hospital stay(d)(12.14±7.13 vs 21.44±9.06,P<0.05);However,the RFA group had less postoperative trauma stress than the resection group and no Secondary platelet increase.There is no difference in the intraoperative blood transfusion rate and postoperative complications of the two groups,the same outcome in fever,pleural effusion,incision split,and incidence of venous thrombosis in the lower extremities(P>0.05).Conclusion Radiofrequency ablation assisted spleen repairing surgery is safe and feasible in patients with stable vital signs of gradeⅠ,ⅡandⅢspleen injury.

关 键 词：创伤性脾破裂 射频消融 脾修补 保脾 脾切除 

分 类 号：R659[医药卫生—外科学]