微波消融在外伤性脾破裂保脾术中的应用分析

Application research of microwave ablation in spleen-preserving surgery in treament of patients with traumatic rupture

目的分析微波消融在外伤性脾破裂保脾术中的临床应用价值。方法外伤性脾破裂患者45例,术前CT评价及术中观察可行保脾术,36例采用单纯微波消融治疗,9例采用微波消融加部分脾切除术。观察术后并发症发生情况,比较术前、术后3天、7天、14天患者外周血血小板的变化情况以评价脾功能。结果围手术期发生左侧胸腔积液15例,脾窝积液伴感染1例,术后2~4天出现发热12例,无术后再出血、血红蛋白尿、胃肠漏、深静脉血栓、胰漏并发症,保留脾脏患者术后7天血小板计数与术前比较,差异有统计意义(P<0.05),术后3天及14天血小板计数与术前比较,差异无统计意义(P>0.05),出院随访2个月,均无死亡病例,术后1~2个月CT扫描及B超检查提示残脾显像良好,未见门静脉血栓。结论微波消融保脾治疗是一种安全、有效的保脾方法,能扩大保脾适应证。

Objective To evalute the indication and clinical application value of microwave abla-tion in spleen-preserving surgery in treament of patients with traumatic rupture.Methods The clinical data of 45 patients with traumatic splenic rupture were retrospectively analyzed.Spleen preserving surgery was feasible by preoperative CT evaluation and intraoperative observation.36 patients received simply mi-crowave ablation,and 9 cases received microwave ablation assisted partial splenectomy.Postoperative com-plications were observed,and the changes of platelet in peripheral blood were detected before and after op-eration in the 3 th,7th,14th day to evaluate the function of spleen.Results 15 patient was complicated with left pleural effusion,1 patient was complicated with splenic fossa fluid associated with infection.Dur-ing the follow-up of at least 2 months,No patients had postoperative bleeding,hemoglobinuria,gastrointes-tinal leak,deep vein thrombosis and pancreatic leak complications,no deaths.Seven days after microwave ablation spleen-preserving surgery,blood platelet count were significantly higher than the levels before the operation （P 〈0.05）in spleen-preserving patients.Platelets were no statistically significant after operation in the 3 th,14thday compared with the preoperative（P 〉0.05）.The CT scan and the ultrasonic examina-tion that reviewed after operation in the 30-60th day showed good in spleen imaging in spleen-preserving patients,No patients had portal vein thrombosis.Conclusion Microwave ablation spleen-preserving sur-gery in the treatment of partial traumatic splenic rupture will be a safe and effective operation which could expand the spleen-preserving indication and be used in clinical practice.