射频凝血器在脾损伤保脾术中的应用

Application of radiofrequency ablation for traumatic splenic preservation

目的 探讨射频消融辅助的保脾术式的临床应用价值.方法 回顾性分析我院2009年9月至2014年6月所收治的70例创伤性脾破裂患者临床资料,根据不同手术方式分为射频消融组（n=35）和传统手术组（n=35）,对2组患者术中、术后相关参数进行统计学对比分析.结果 射频消融组34例患者通过该方法保脾成功（成功率97％）,传统手术组保脾成功26例（成功率74％）,2组比较差异有统计学意义（x2=7.467,P＜0.05）;射频消融组平均手术时间、术中出血量及术中输血例数分别为：[（80±22）min、（116±66）ml、5例],明显优于传统手术组[（122±28） min、（237±192）ml、13例],2组比较差异有统计学意义（t=4.58,t=3.324,x2=4.786,P＜0.05）.射频消融组术后出血量、住院时间、输血例数[（113 ±72）ml、（7.8±1.2）d、2例]明显优于传统手术组[（246±140） ml、（t0.2±1.6）d、8例],2组比较差异有统计学意义（t=3.267,t=4.536,x2 =4.9,P＜0.05）.术后2组并发症比较差异无统计学意义（x2=0.913,P＞0.05）.结论 与传统保脾手术相比,射频消融法简单实用,降低了保脾手术难度及风险,最大限度的保留了脾脏及其功能.

Objective To evaluate radiofrequency ablation （RFA） assisted splenic preservation in traumatic splenic rupture.Methods Data of 70 cases with traumatic rupture of the spleen at our hospital from Septembcr 2009 to June 2014 were retrospectively analysed.Patients were divided into two groups according to different surgical methods,namely,RFA group （n =35） and control conventional surgery group （n =35）.Results In the RFA group,34 cases underwent successful spleen preserving operation,the success rate was 97%.In control group,26/35 cases received splenic preservation operations successfully,the success rate was 74% （26/35） （x2 =7.467,P 〈 0.05）.Average operation time,bleeding during operation and intra-operative transfusion in RFA group were （80 ± 22） min,（116 ± 66） ml and 5 cases,rcspectively,significantly better than that in control of group.（122 ± 80） min,（237 ± 192） ml and 13 cases,respectively （t =4.58,t =3.324;x2 =4.786,P 〈 0.05）.Postoperative bleeding,hospital stay and cases receiving transfusion in RFA group were （113 ± 72）ml,（7.8 ± 1.2） d and 2 cases,respectively,which were remarkably better than those in control group of （246 ± 140） ml,（10.2 ± 1.6） d and 8 cases （t =3.267,t =4.536;x2 =4.9;P 〈 0.05）.Postoperative complications in the two groups were similar （x2 =0.913,P 〉 0.05）.Conclusions Compared with traditional spleen preserving surgery,RFA is simple and effective.It can greatly reduce the difficulty and risks of splenic preservation surgery,increasing the preservation of ruptured spleen.