CAJ | 학술논문

目的探讨RFA辅助保脾术治疗外伤性脾破裂的疗效.方法回顾性分析2010年8月至2012年5月遂宁市中心医院收治的64例外伤性脾破裂患者的临床资料.采用射频凝固止血器直接在脾脏裂口周围凝固止血,观察临床效果.结果 64例行RFA辅助保脾术的患者中,35例行RFA辅助脾裂口止血术,29例行RFA辅助脾部分切除术,平均手术时间为(138 ±48) min,术中出血量为50 ～400 ml.63例患者保脾成功,1例因术后24 h大出血,再次行手术治疗,术中发现系胃短血管断裂出血(为第1次手术未发现所致),行脾全切除术.本组患者术后体温均有一过性升高,但经常规处理或观察数日后均下降至正常水平.63例保脾成功的患者,并发症发生率为6.3％(4/63),其中l例为胃破裂修补失败导致吻合口漏,再次修补后痊愈出院；1例为左侧胸腔积液,观察数日后自行吸收；1例为肺部感染,发热4d后经对症治疗体温控制；1例为脾窝少量积液,观察数日后自行吸收.全组患者术后放置引流管,术后第1天引流量为10 ～120ml,术后第2～3天为5～25 ml,于第3天全部拔除引流管.术后2周行CT检查示脾脏质地均匀,脾周无明显积液.本组患者住院时间为(14±4)d(8 ～40 d)；术后1个月复查B超无明显脾周积液及脾坏死灶,且免疫功能检查示脾脏功能正常.结论 RFA辅助保脾术简单易行,安全可靠.
목적 탐토RFA보조보비술치료외상성비파렬적료효.방법 회고성분석2010년8월지2012년5월수저시중심의원수치적64예외상성비파렬환자적림상자료.채용사빈응고지혈기직접재비장렬구주위응고지혈,관찰림상효과.결과 64례행RFA보조보비술적환자중,35례행RFA보조비렬구지혈술,29례행RFA보조비부분절제술,평균수술시간위(138 ±48) min,술중출혈량위50 ～400 ml.63례환자보비성공,1례인술후24 h대출혈,재차행수술치료,술중발현계위단혈관단렬출혈(위제1차수술미발현소치),행비전절제술.본조환자술후체온균유일과성승고,단경상규처리혹관찰수일후균하강지정상수평.63례보비성공적환자,병발증발생솔위6.3％(4/63),기중l례위위파렬수보실패도치문합구루,재차수보후전유출원；1례위좌측흉강적액,관찰수일후자행흡수；1례위폐부감염,발열4d후경대증치료체온공제；1례위비와소량적액,관찰수일후자행흡수.전조환자술후방치인류관,술후제1천인류량위10 ～120ml,술후제2～3천위5～25 ml,우제3천전부발제인류관.술후2주행CT검사시비장질지균균,비주무명현적액.본조환자주원시간위(14±4)d(8 ～40 d)；술후1개월복사B초무명현비주적액급비배사조,차면역공능검사시비장공능정상.결론 RFA보조보비술간단역행,안전가고.
Objective To investigate the efficacy of radiofrequency ablation assisted spleen-preservation for splenic injury.Methods The clinical data of 64 patients with splenic injury who were admitted to the Suining Central Hospital from August 2010 to May 2012 were retrospectively analyzed.Radiofrequency coagulation hemostasis devices were used for stanching bleeding directly.Results Of the 64 patients,35 received radiofrequency ablation assisted splenic bleeding stemosis,and 29 received radiofrequency ablation assisted partial splenectomy.The mean operation time and volume of intraoperative blood loss were (138 ± 48)minutes and 50-400 ml,respectively.Radiofrequency ablation assisted spleen-preservation was successfully carried out in 63 patients.One patient received reoperation (splenic resection) due to hemorrhage 24 hours after operation.Transient rise of temperature was detected in all the patients,and the temperature was back to normal after conventional management.The complication rate was 6.3％ (4/63),l patient was complicated with anastomotic leakage and was cured by reoperation; 1 was complicated with left pleural effusion; 1 was complicated with pulmonary infection,and his temperature was back to normal 4 days later; 1 was complicated with effusion in the fossa of the spleen.Celiac drainage tube drainaged out 10-120 ml liquid in the first day after operation,5-25 ml on the day 2-3,and they were removed on the third day.There was no effusion around the spleens,and the texture of the spleen was even at 2 weeks after operation.The duration of hospital stay was (14 ±4)days (range,8-40 days).The results of B sonography showed that no effusion and necrotic lesions in the spleen,and immune examinations showed that the splenic function was normal.Conclusion Radiofrequency ablation assisted spleen-preservation for splenic injury is safe and easy to manipulate.