射频消融在外伤性脾破裂保脾手术中的应用

The experience of radiofrequency ablation on spleen preserving operation for splenic injury

目的探讨射频消融（RFA）在外伤性脾破裂保脾手术中的临床疗效。方法回顾性分析肝胆外科2010年4月~2014年7月收治的外伤性脾破裂患者45例,根据中华医学会外科学分会脾脏学组脾损伤分级,其中行脾切除18例（Ⅳ级）,单纯性射频消融5例（Ⅰ级）、射频消融下脾部分切除22例（Ⅱ~Ⅲ级）,术后1月随访患者复查B超、血小板、免疫球蛋白、补体C3、补体C4等指标。结果所有保脾患者手术均获得成功,平均手术时间为（120±48）min,术中出血量为50~200ml,术后均未出现脾脏再出血,住院时间12~20天,无严重并发症发生,术后1月复查B超未出现脾梗死、脾脓肿,血小板、免疫球蛋白及补体C3、C4等指标均在正常范围。结论外伤性脾破裂患者可根据脾脏损伤分级选择合理的手术方式,对于Ⅰ~Ⅲ级患者采用射频消融进行保脾手术是一种简单、安全、可靠、有效的方法。

Objective To investigate the efficacy of radiofrequency ablation on spleen preserving operation for splenic injury.Methods We retrospectively analyzed 45 patients with traumatic rupture spleen,including splenectomy（18cases,gradeⅣ）and of simple radiofrequency ablation（5cases,gradeⅠ）,partial splenectomy with radiofrequency ablation（22cases,grade Ⅱ-Ⅲ）,according to the grade of Spleen Science Society study group of the Chinese Medical Association.All patients were cured and checked B ultrasound,platelet,immunoglobulin,complement C3 and complement C4 one month after spleen-preservation operation.Results all patients of spleen-preservation operation were successful.The mean operation time and volume of intraoperative blood loss were（120±48）minutes and 50-200 ml.No rebleeding and serious complication occurred.The duration of hospital stay was 12-20 days.There were no splenic infarction and splenic abscess occurred by reviewing ultrasound and platelet,immunoglobulin,complement C3 and complement C4 were normal one month after operation.Conclusion Patients with traumatic rupture of spleen must be selected reasonable surgical procedure according to the grade of splenic injury and radiofrequency ablation assisted spleen-preservation for splenic injury,which is safe and easy to manipulate for patients in GradeⅠ-Ⅲ.