Department of Visceral Surgery, HIA Desgenettes, 108 Boulevard Pinel, Lyon, France.
Surg Endosc. 2012 Apr;26(4):1163-4. doi: 10.1007/s00464-011-2010-9. Epub 2011 Nov 2.
Iatrogenic splenic injury is a potentially serious complication of laparoscopic surgery associated with significant morbidity and mortality. It also has an impact on the prognosis of patients who undergo surgery for digestive cancer. For iatrogenic splenic injury, splenic salvage is the ultimate goal. Various surgical techniques have been developed to achieve hemostasis of the spleen. Radiofrequency fulguration (RF) is reported to be a safe method in an animal trauma model. However, only three articles report RF for the control of splenic hemorrhage in human patients.
A bicentric, retrospective study was performed. From January 2009 to September 2010, all iatrogenic splenic hemorrhages uncontrolled by conventional hemostasis techniques were treated using RF. The splenic injuries were classified according to the Moore classification and a postoperative, abdominal computed tomography scan was performed for each patient. RF was performed with a straight electrode needle (Integra, Tuttlingen, Germany) introduced percutaneously into the spleen. The electrode was infused with isotonic saline and connected to a 500-kHz generator (Elektrotom 106 HFTT; Berchtold, Tuttlingen, Germany). During the high-frequency coagulation (375 kHz), electrode saline perfusion was automatically regulated from 30 to 110 ml/h according to the variation in tissue impedance, and the power of the generator was kept at 50 W.
Three patients (2 men and 1 woman) with a median age of 58 years underwent splenic RF. The splenic injuries (grade 3, Moore classification) occurred during laparoscopic proctectomy in two cases and during laparoscopic gastrectomy in one case. It was possible to achieve complete hemostasis in all the patients during a median time of 10 min. The median blood loss was 100 ml, with no blood transfusion. No splenectomy was necessary, and no postoperative splenic infarction was diagnosed. No conversion was performed. There was no postoperative morbidity or mortality. No recurrent splenic hemorrhage occurred during the follow-up period. The financial cost was 350
Although RF could potentially induce splenic infarction in the event of a large-scale fulguration, it is a safe, quick, and effective spleen-preserving technique for stopping an iatrogenic splenic hemorrhage when conventional hemostasis techniques fail. Furthermore, it is readily available and easy to set up in an emergency situation and can be performed easily by laparoscopy without an additional port.
医源性脾损伤是腹腔镜手术中一种潜在的严重并发症，与显著的发病率和死亡率有关。它还会影响因消化道癌症而行手术的患者的预后。对于医源性脾损伤，脾保留是最终目标。已经开发了各种外科技术来实现脾止血。射频灼烙术（RF）在动物创伤模型中被报道是一种安全的方法。然而，只有三篇文章报告了 RF 用于控制人类患者的脾出血。
进行了一项双中心回顾性研究。从 2009 年 1 月至 2010 年 9 月，所有通过常规止血技术无法控制的医源性脾出血均采用 RF 治疗。根据 Moore 分类对脾损伤进行分类，并对每位患者进行术后腹部计算机断层扫描。使用直电极针（Integra，图特林根，德国）经皮引入脾内进行 RF。将电极浸入等渗盐水中，并连接到 500-kHz 发生器（Elektrotom 106 HFTT；Berchtold，图特林根，德国）。在高频凝固（375 kHz）期间，根据组织阻抗的变化，电极盐水灌注自动调节为 30-110 ml/h，发生器的功率保持在 50 W。
三名患者（2 名男性和 1 名女性），中位年龄 58 岁，行脾 RF。两名患者在腹腔镜直肠切除术和一名患者在腹腔镜胃切除术中发生脾损伤（Moore 分类 3 级）。所有患者中位时间 10 分钟即可实现完全止血。中位出血量为 100 ml，无需输血。无需行脾切除术，术后未诊断出脾梗死。未进行转换。无术后并发症或死亡。随访期间无复发性脾出血。RF 的费用为每例 350 欧元。
尽管 RF 在大范围灼烙时可能会导致脾梗死，但当常规止血技术失败时，它是一种安全、快速、有效的保脾技术，可用于停止医源性脾出血。此外，它在紧急情况下易于获得和设置，并且可以通过腹腔镜轻松进行，无需额外的端口。
