射频消融在脾脏外伤后保脾手术中的临床应用_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

吕涛 ,  蒋晓忠 , 罗洪 , 陶友江

宜宾市第二人民医院（四川宜宾 644000）;

Corresponding author：

蒋晓忠, Email: 465963498@qq.com

Keywords：

脾脏外伤; 射频消融; 保脾手术

DOI：

10.7507/1007-9424.201702069

Video：

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目的探讨射频消融在保脾手术治疗脾脏外伤中的临床应用效果。方法回顾性分析笔者所在医院科室于 2010 年 7 月至 2015 年 3 月期间行保脾手术治疗的 23 例脾脏外伤患者的临床资料，术中均利用了射频消融技术。结果 23 例患者均保脾成功，其中 11 例行射频消融止血修补术，12 例行射频消融联合部分脾脏切除术。手术时间为 75～150 min，平均 117 min；术中出血量为 40～500 mL，平均 223 mL；术中见腹腔出血量 800～2 000 mL，平均 1 452 mL，均行自体血回输；术中见脾脏裂伤程度：Ⅰ 度 10 例，Ⅱ 度 11 例，Ⅲ 度 2 例；拔除引流管时间为术后 2～5 d，平均 2.8 d；术后住院时间为 6～15 d，平均 8.5 d。术后出现发热 3 例，腹腔再次出血 1 例，血小板计数升高 7 例。术后获访 16 例，随访时间 8～26 个月，中位数为 11 个月。随访期间患者健康情况良好，未见血小板计数异常、脾脓肿等情况。结论射频消融在保脾手术治疗脾脏外伤中的应用是可行的。

Citation： 吕涛, 蒋晓忠, 罗洪, 陶友江. 射频消融在脾脏外伤后保脾手术中的临床应用. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(10): 1258-1260. doi: 10.7507/1007-9424.201702069 Copy

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13.	陈广平, 苗金照. 创伤性脾破裂保脾手术中脾动脉结扎分析. 浙江临床医学, 2007, 9(10): 1376.0.
14.	Stey AM, Ko CY, Hall BL, et al. Are procedures codes in claims data a reliable indicator of intraoperative splenic injury compared with clinical registry data? J Am Coll Surg, 2014, 219(2): 237-244.
15.	van der Vlies CH, Hoekstra J, Ponsen KJ, et al. Impact of splenic artery embolization on the success rate of nonoperative management for blunt splenic injury. Cardiovasc Intervent Radiol, 2012, 35(1): 76-81.
16.	McIntyre LK, Schiff M, Jurkovich GJ. Failure of nonoperative management of splenic injuries: causes and consequences. Arch Surg, 2005, 140(6): 563-568.
17.	黄志强, 裘法祖. 腹部外科手术学. 长沙: 湖南科学技术出版社, 2001: 662-664.

1. Sosada K, Wiewióra M, Piecuch J. Literature review of non-operative management of patients with blunt splenic injury: impact of splenic artery embolization. Wideochir Inne Tech Maloinwazyjne, 2014, 9(3): 309-314.
2. Rong JJ, Liu D, Liang M, et al. The impacts of different embolization techniques on splenic artery embolization for blunt splenic injury: a systematic review and meta-analysis. Mil Med Res, 2017, 4: 17.
3. 中华医学会外科学分会脾功能与脾脏外科学组. 脾脏损伤治疗方式的专家共识(2014版). 中华普通外科学文献(电子版), 2015, 9(2): 83-85.
4. Mossadegh S, Midwinter M, Sapsford W, et al. Military treatment of splenic injury in the era of non-operative management. J R Army Med Corps, 2013, 159(2): 110-113.
5. Huang GS, Chance EA, Hileman BM, et al. Laparoscopic splenectomy in hemodynamically stable blunt trauma. JSLS, 2017, 21(2). e2017.
6. Walker ML. Nonoperative management of the damaged spleen: a community surgeon looks back. Am Surg, 2017, 83(5): 502-506.
7. Chavan SS, Tracey KJ. Essential neuroscience in immunology. J Immunol, 2017, 198(9): 3389-3397.
8. Sinha S, Raja SV, Lewis MH. Recent changes in the management of blunt splenic injury: effect on splenic trauma patients and hospital implications. Ann R Coll Surg Engl, 2008, 90(2): 109-112.
9. 王国梁, 张燕. 外伤性脾破裂术中保脾技术的应用. 中华肝胆外科杂志, 2003, 10(9): 629-630.0.
10. Pisters PW, Pachter HL. Autologous spleen transplantion for spleen trauma. Ann Surg, 1994, 219(3): 225-235.
11. 陈维佩, 韩殿冰. 脾脏的血管解剖与保脾手术. 中国实用外科杂志, 1999, 19(12): 710-712.0.
12. Zarzaur BL, Dunn JA, Leininger B, et al. Natural history of splenic vascular abnormalities after blunt injury: A Western Trauma Association multicenter trial. J Trauma Acute Care Surg, 2017, [Epub ahead of print].
13. 陈广平, 苗金照. 创伤性脾破裂保脾手术中脾动脉结扎分析. 浙江临床医学, 2007, 9(10): 1376.0.
14. Stey AM, Ko CY, Hall BL, et al. Are procedures codes in claims data a reliable indicator of intraoperative splenic injury compared with clinical registry data? J Am Coll Surg, 2014, 219(2): 237-244.
15. van der Vlies CH, Hoekstra J, Ponsen KJ, et al. Impact of splenic artery embolization on the success rate of nonoperative management for blunt splenic injury. Cardiovasc Intervent Radiol, 2012, 35(1): 76-81.
16. McIntyre LK, Schiff M, Jurkovich GJ. Failure of nonoperative management of splenic injuries: causes and consequences. Arch Surg, 2005, 140(6): 563-568.
17. 黄志强, 裘法祖. 腹部外科手术学. 长沙: 湖南科学技术出版社, 2001: 662-664.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

射频消融在脾脏外伤后保脾手术中的临床应用

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