基于射频及自体血回输的脾破裂保脾术在基层医院的疗效分析

Therapeutic efficacy of spleen-preserving surgery assisted by radiofrequency and autologous blood transfusion in primary hospitals

摘要:

目的： 探讨基于射频消融（radiofrequency ablation，RFA）及自体血回输（autologous blood transfusion，ABT）辅助的创伤性脾破裂保脾术在基层医院的临床疗效，提高基层医院创伤性脾破裂治疗水平。方法： 回顾2015年1月至2020年5月在四川省简阳市人民医院（县级医院）接受脾破例手术的患者98例，其中采用脾切除术治疗37例（A组），传统保脾术治疗14例（B组），RFA辅助保脾术治疗47例（C组），比较3组手术效果、并发症及术后血小板（platelet，PLT）情况。结果： 保脾成功率：C组高于B组（P=0.035）；手术时间：3组比较差异有统计学意义（F=20.432，P=0.000）；组间比较：C组及A组比B组手术时间短（P=0.000、0.000），A组比C组手术时间短（P=0.008）；术中出血：3组比较，差异有统计学意义（F=5.462，P=0.006）；组间比较：C组及A组比B组出血少（P=0.010、0.001），A组及C组比较（P=0.311）差异无统计学意义；自体血回输率：3组比较差异有统计学意义（χ²=7.607，P=0.028）；组间比较：C组比A组回输率高（P=0.012），A、B组比较（P=1.000）及B、C组比较（P=0.124）差异无统计学意义；术后血红蛋白（hemoglobin，HB）情况：3组差异无统计学意义（F=2.864，P=0.062）；住院时间：3组比较差异有统计学意义（F=3.806，P=0.028）；组间比较：C组比A组住院时间短（P=0.010），A、B组比较（P=0.100）及B、C组比较（P=0.708）差异无统计学意义；术后并发症：C组相比A、B组并发症发生率更低，但差异无统计学意义（χ²=1.180，P=0.532）；3组患者分别于术后3 d、7 d、15 d及1个月查血小板（blood platelet，PLT），结果提示：3组间差异具有统计学意义（F=8.550、4.261、4.304、11.505，P=0.000、0.017、0.016、0.000）；组间比较：C组及B组比A组PLT升高程度更低（P=0.000、0.007、0.008、0.000，0.004、0.047、0.038、0.001），B组及C组比较（P=0.815、0.929、0.837、0.932）差异无统计学意义。结论： RFA联合术中ABT在创伤性脾破裂保脾手术应用中，保脾成功率高，能够缩短手术时间、减少术中出血、降低血小板升高程度等，是一种安全有效的保脾方法，适合在基层医院推广。

Abstract:

Objective: To investigate the clinical therapeutic effect of spleen-preserving surgery for traumatic spleen rupture based on radiofrequency ablation (RFA) and autologous blood transfusion (ABT), and to improve the treatment of traumatic splenic rupture in primary hospitals. Methods: Data of 98 cases with traumatic splenic rupture treated in our hospital from January 2015 to May 2020 were retrospectively analyzed, among which, 37 cases underwent splenectomy (group A), 14 cases underwent traditional spleen-preserving operation (group B) and 47 cases underwent RFA-assisted spleen-preserving operation (group C). The operation effect, complications and postoperative blood platelet (PLT) count of the three groups were compared and analyzed. Results: The success rate of spleen-preserving surgery in group C was higher than that in group B (P=0.035). There were significant differences among the three groups in operation time (F=20.432, P=0.000). Comparison between groups: the operation time of group C and group A were shorter than that of group B (P=0.000, 0.000), as well as group A had shorter time than group B had (P=0.008). There were significant differences in intraoperative bleeding among the three groups (F=5.462, P=0.006). Comparison between groups: group C and group A had less bleeding than group B had (P=0.010, 0.001), while there was no significant difference between group A and group C (P=0.311). ABT ratio: the differences among the three groups were statistically significant (χ²=7.607, P=0.028); comparison between groups: group C was higher than group A (P=0.012), while there was no significant difference between group A and group B (P=1.000), neither in group B and group C (P=0.124). There were no significant differences among the three groups in postoperative hemoglobin (HB) (F=2.864, P=0.062). The differences in hospitalization time among the three groups were statistically significant (F=3.806, P=0.028); comparison between groups: the hospitalization in group C was shorter than that in group A (P=0.010), while there was no significant difference between group A and group B (P=0.100), neither in group B and group C (P=0.708). Postoperative complications: the incidence in group C was lower than that in group A and group B, without statistical differences (χ²=1.180, P=0.532). PLT was respectively checked for three groups of patients on the 3rd, 7th, 15th and 1st month after the operation, and the results showed that the differences among the three groups were statistically significant (F=8.550, 4.261, 4.304, 11.505, P=0.000, 0.017, 0.016, 0.000); comparison between groups: the level of PLT elevation were lower in group C and group B than in group A (P=0.000, 0.007, 0.008, 0.000; 0.004, 0.047, 0.038, 0.001), while there was no significant difference between group B and group C (P=0.815, 0.929, 0.837, 0.932). Conclusion: RFA combined with intraoperative ABT is a safe and effective method for spleen-preserving operation in traumatic splenic rupture, with high success rate, shortened operation time, reduced intraoperative bleeding, and decreased degree of PLT elevation, which is suitable for promotion in primary hospitals.