射频消融辅助保脾术的疗效

Efficacy of radiofrequency ablation assisted spleen-preservation for splenic injury

目的探讨RFA辅助保脾术治疗外伤性脾破裂的疗效。方法回顾性分析2010年8月至2012年5月遂宁市中心医院收治的64例外伤性脾破裂患者的临床资料。采用射频凝固止血器直接在脾脏裂口周围凝固止血，观察临床效果。结果64例行RFA辅助保脾术的患者中，35例行RFA辅助脾裂口止血术，29例行RFA辅助脾部分切除术，平均手术时间为（138±48）min，术中出血量为50—400ml。63例患者保脾成功，1例因术后24h大出血，再次行手术治疗，术中发现系胃短血管断裂出血（为第1次手术未发现所致），行脾全切除术。本组患者术后体温均有一过性升高，但经常规处理或观察数日后均下降至正常水平。63例保脾成功的患者，并发症发生率为6．3％（4／63），其中1例为胃破裂修补失败导致吻合口漏，再次修补后痊愈出院；1例为左侧胸腔积液，观察数日后自行吸收；1例为肺部感染，发热4d后经对症治疗体温控制；1例为脾窝少量积液，观察数日后自行吸收。全组患者术后放置引流管，术后第1天引流量为10—120ml，术后第2—3天为5—25m1，于第3天全部拔除引流管。术后2周行CT检查示脾脏质地均匀，脾周无明显积液。本组患者住院时间为（14±4）d（8—40d）；术后1个月复查B超无明显脾周积液及脾坏死灶，且免疫功能检查示脾脏功能正常。结论RFA辅助保脾术简单易行，安全可靠。

Objective To investigate the efficacy of radiofrequency ablation assisted spleen-preservation for splenic injury. Methods The clinical data of 64 patients with splenic injury who were admitted to the Suining Central Hospital from August 2010 to May 2012 were retrospectively analyzed. Radiofrequency coagulation hemo- stasis devices were used for stanching bleeding directly. Results Of the 64 patients, 35 received radiofreqnency ablation assisted splenic bleeding stemosis, and 29 received radiofrequency ablation assisted partial splenectomy. The mean operation time and volume of intraoperative blood loss were （138 ~48 ）minutes and 50-400 ml, respec- tively. Radiofrequency ablation assisted spleen-preservation was successfully carried out in 63 patients. One patient received reoperation （ splenic resection ） due to hemorrhage 24 hours after operation. Transient rise of temperature was detected in all the patients, and the temperature was back to normal after conventional manage- ment. The complication rate was 6.3% （4/63） , 1 patient was complicated with anastomotic leakage and was cured by reoperation; 1 was complicated with left pleural effusion; 1 was complicated with pulmonary infection, and his temperature was back to normal 4 days later; 1 was complicated with effusion in the fossa of the spleen. Celiac drainage tube drainaged out 10-120 ml liquid in the first day after operation, 5-25 ml on the day 2-3, and they were removed on the third day. There was no effusion around the spleens, and the texture of the spleen was even at 2 weeks after operation. The duration of hospital stay was （ 14 ~ 4） days （ range, 8-40 days）. The results of B sonography showed that no effusion and necrotic lesions in the spleen, and immune examinations showed that the splenic function was normal. Conclusion Radiofrequency ablation assisted spleen-preservation for splenic injury is safe and easy to manipulate.