ERAS理念下射频消融联合部分脾切除术治疗创伤性脾破裂的可行性与安全性  

Feasibility and safety of radiofrequency ablation plus partial splenectomy in the treatment of traumatic splenic rupture under the concept of enhanced recovery after surgery

作　　者：赵健 林嘉明 马铎 喻智勇 Zhao Jian;Lin Jiaming;Ma Duo;Yu Zhiyong(DepartmentⅡof General Surgery,Affiliated Hospital,Yunnan University,Yunnan Kunming 650000,China)

机构地区：[1]云南大学附属医院普外二科,云南昆明650000

出　　处：《腹部外科》2022年第2期120-123,145,共5页Journal of Abdominal Surgery

基　　金：王曙光专家工作站资助项目(2018IC107)。

摘　　要：目的探讨加速术后康复(enhanced recovery after surgery,ERAS)理念下射频消融联合部分脾切除术治疗创伤性脾破裂的可行性与安全性。方法回顾性分析2014年9月至2020年12月确诊的创伤性脾破裂行ERAS理念下射频消融联合部分脾切除术28例病人的临床资料。结果所有病人均手术成功。平均手术时间为150 min(120~240 min),平均术中出血量为250 mL(150~400 mL),平均住院时间为7.2 d(5~14 d);围术期无出血、胰漏、腹腔感染等严重并发症;随访3~6个月,无明显血小板升高、门静脉血栓、脾区脓肿和免疫功能减低。结论ERAS理念下射频消融联合部分脾切除术具有安全、可靠、并发症少、恢复快等优势,同时保存了健康脾脏、保留了正常的免疫和生理功能,值得临床推广。应用中尚需合理选择病人,准确评估伤情,进一步优化手术流程和ERAS管理。Objective To explore the feasibility and safety of radiofrequency ablation(RFA)plus partial splenectomy in the treatment of traumatic splenic rupture under the concept of enhanced recovery after surgery(ERAS).Methods From September 2014 to March 2021,clinical data were retrospectively reviewed for 28 patients undergoing RFA plus partial splenectomy under the concept of ERAS.Results All operations were successfully performed.Average operative duration was 150(120-240)min,average intraoperative volume of blood loss 250(150-400)mL and average length of hospital stay 7.2(5-14)days.No serious complications,such as hemorrhage,pancreatic leakage or abdominal infection,occurred during perioperative period.Follow-ups for 3-6 months showed no obvious elevation of platelet,portal vein thrombosis,splenic abscess or impaired immune function.Conclusion Under the concept of ERAS,RFA plus partial splenectomy offers the advantages of higher safety,greater reliability,fewer complications and quicker recovery.At the same time,it retains healthy spleen and normal immune and physiological functions.A wider popularization is worthwhile.In clinical practices,it is necessary to select patients reasonably,evaluate injuries accurately and further optimize surgical procedures and ERAS managements.

关 键 词：加速术后康复 创伤性脾破裂 射频消融 部分脾切除 安全性 

分 类 号：R657.6[医药卫生—外科学]