射频消融辅助保脾术治疗创伤性脾破裂的疗效  

Efficacy of radiofrequency ablation assisted spleen-preservation surgery for the treatment of traumatic splenic rupture

作　　者：王威[1] 夏辉[1] Wang Wei;Xia Hui(Department of Hepatobiliary Surgery,Wuhan No.1 Hospital,Wuhan 430022,China)

机构地区：[1]武汉市第一医院肝胆外科,武汉430022

出　　处：《创伤外科杂志》2021年第11期848-853,共6页Journal of Traumatic Surgery

基　　金：湖北省自然科学基金项目(2014CFC1042)。

摘　　要：目的探讨射频消融辅助保脾术治疗创伤性脾破裂的临床疗效。方法回顾性分析2017年1月—2020年6月武汉市第一医院肝胆外科收治的80例创伤性脾破裂患者的临床资料,男性58例,女性22例;年龄22~49岁,平均39.4岁;致伤原因道路交通伤31例,高处坠落伤30例,击打伤19例。患者按术式不同分为两组44例腹腔镜下根据损伤分级进行裂口射频消融止血后修复脾脏(射频组),36例行腹腔镜下常规止血并修复脾脏(传统组)。比较两组手术指标、保脾成功率、术后并发症发生率,术前及术后3、7、14、30d检测血小板计数(PLT),术前及术后30d检测血清免疫球蛋白(IgA、IgG、IgM)和Tuftsin因子水平。结果射频组的手术时间、术中出血量、术后24h引流量、首次排气时间、住院时间分别为(110.01±22.31)min、(152.36±20.71)mL、(142.17±25.59)mL、(17.03±3.21)h、(10.21±3.04)d,均较传统组的(139.75±30.26)min、(271.44±36.85)mL、(254.69±30.31)mL、(24.32±4.11)h、(13.22±3.56)d明显减少(P<0.05),但治疗费用高于传统组(P<0.05);射频组保脾成功率为97.73%,高于传统组的83.33%(P<0.05);射频组输血率和并发症发生率为6.82%和4.54%,均低于传统组的25.00%、22.22%(P<0.05)。术后3、7、14、30d,两组PLT均高于术前(P<0.05),但两组间比较差异无统计学意义(P>0.05)。术后30d,射频组的IgA、IgG、IgM及Tuftsin因子水平下降不明显,传统组显著下降,且传统组显著低于射频组(P<0.05)。结论射频消融辅助保脾术治疗创伤性脾破裂可缩短手术时间并减少出血量,降低输血率及并发症发生率,可能更有利于保护残余脾功能及免疫功能。Objective To explore the clinical efficacy of radiofrequency ablation assisted spleen-preservation surgery for the treatment of traumatic splenic rupture.Methods The clinical data of 80 patients with traumatic splenic rupture admitted to the Department of Hepatobiliary Surgery,Wuhan No.1 Hospital from Jan.2017 to Jun.2020 were retrospectively analyzed.There were 58 males and 22 females;their age ranged from 22 to 49 years,with an average of 39.4 years;causes of injury:31 cases of road traffic injuries,30 cases of falling injuries,and 19 cases of beating injuries.Patients were divided into two groups according to different surgical procedures:44 cases of radiofrequency ablation assisted spleen preservation were treated as radiofrequency group,and 36 cases of traditional spleen preservation were treated as traditional group.The surgical indicators,the success rate of spleen-preservation,and the incidence of postoperative complications were compared between the two groups.The platelet count(PLT)was detected before operation and 3,7,14,and 30 days after operation,and the serum immunoglobulin(IgA,IgG,IgM)and Tuftsin factor levels were detected before operation and 30 days after the operation.Results The operation time,intraoperative blood loss,postoperative 24 h drainage,the first exhaust time,and hospital stay in the radiofrequency group were(110.01±22.31)minutes,(152.36±20.71)mL,(142.17±25.59)mL,(17.03±3.21)hours and(10.21±3.04)days,respectively,which were significantly reduced compared with the traditional group[(139.75±30.26)minutes,(271.44±36.85)mL,(254.69±30.31)mL,(24.32±4.11)hours,(13.22±3.56)days],P<0.05,but the treatment cost was higher than that of the traditional group(P<0.05).The success rate of spleen-preservation in the radiofrequency group was 97.73%,which was higher than 83.33%in the traditional group(P<0.05);the blood transfusion rate and complication rate of the radiofrequency group was 6.82%and 4.54%,respectively.Which were lower than those of the traditional group(25.00%and 22.22%,P<0.05)

关 键 词：创伤性脾破裂 射频消融 保脾术 免疫球蛋白 

分 类 号：R657.6[医药卫生—外科学]