摘要
目的探讨腹腔镜联合射频消融在创伤性脾破裂保脾术中的应用价值。方法 2014年3月~2016年3月我科应用腹腔镜联合射频消融手术治疗创伤性脾破裂34例,在腹腔镜引导下,将射频消融凝血器电极插入表浅脾脏裂口或深大裂口两侧正常脾组织射频止血,完成后脾周放置引流管。结果 2例术中证实为Ⅳ级损伤,改行脾切除术;1例术后24 h内出血,腹腔引流量>100 ml/h,二次探查证实为消融灶内动脉血管破裂,行脾切除术。保脾成功率91.1%(31/34),无围手术期死亡。手术时间35~120 min,(65±30)min。术中出血100~400 ml,(240±90)ml。胸腔积液6例,1例胸腔积液>800 ml经穿刺引流后治愈,其余5例保守治疗痊愈;无腹腔脓肿(脾脓肿),脾梗死、继发血肿等严重并发症。住院7~9 d,平均7.5 d。31例随访1~6个月,脾脏无坏死、萎缩,血小板计数、免疫功能指标正常。结论在严格把握适应证的情况下,腹腔镜联合射频消融治疗创伤性脾破裂可降低保脾难度及风险,安全可行。
Objective To explore the value of the laparoscopy combined with radiofrequency ablation in splenic preservation surgery for treatment of traumatic splenic rupture. Methods From March 2014 to March 2016,34 patients with traumatic splenic rupture received laparoscopy combined with radiofrequency ablation in splenic preservation surgery in our hospital. Under the guidance of laparoscopy,the coagulator electrode of radiofrequency ablation therapy instrument was inserted into the splenic fissure or adjacent normal splenic tissue for ablation to stop bleeding. A drainage tube was placed around the spleen after ablation. Results Two cases were transferred to splenectomy for a grade Ⅳ injury. One patient underwent re-operation of splenectomy for postoperative hemorrhage within 24 h（ abdominal drainage 100 ml）,during which a arterial rupture in ablation region was found. The success rate of splenic preservation was 91. 1%（ 31/34）. No peri-operative death occurred. The operative duration time was 35-120 min（ mean,65 ± 30 min）. The intraoperative blood loss was 100-400 ml（ mean,240 ± 90 ml）. No severe complications were observed. Pleural effusion was found in 6 cases,including 1 case 〉800 ml receiving puncture drainage and 5 cases receiving conservative treatment. No abdominal abscess（ splenic abscess）,spleen infarction,or secondary hematoma happened. The hospitalization time was 7-9 d（ mean,7. 5 d）. A total of 31 patients were followed up for 1-6 months. No spleen necrosis or atrophy was observed,as well as platelet count and the index of immune function were in the normal range. Conclusion The laparoscopy combined with radiofrequency ablation reduces the difficulty and risks of splenic preservation surgery,being an applicable way for traumatic splenic rupture.
作者
丁红健
苏畅
陈前
刘绍群
茅安炜
陈义
曹奕鸥
Ding Hongjian, Su Chang, Chen Qian, et al.(Department of Surgery, Minhang Branch, Zhongshan Hospital, Fudan University, Shanghai 201199,Chin)
出处
《中国微创外科杂志》
CSCD
北大核心
2018年第7期594-596,共3页
Chinese Journal of Minimally Invasive Surgery
关键词
脾破裂
腹腔镜
射频消融
Splenic rupture
Laparoscopy
Radiofrequency ablation
