摘要
目的探讨肝癌切除手术中使用双极电凝镊进行肝脏离断的临床应用价值。方法回顾性分析2020年1月至2021年1月于汕头大学医学院附属粤北人民医院肝胆外科接受肝癌切除手术的63例肝癌患者的病例资料。根据术中采用的肝脏离断器械不同,将患者分为镊夹组(n=32)和超声刀组(n=31)。镊夹组中男性22例,女性10例,年龄(55.5±10.5)岁(范围:37~78岁);肿瘤最大径(6.0±3.4)cm(范围:2.4~13.4 cm),6例有门静脉癌栓,5例有门静脉高压症。超声刀组中男性27例,女性4例,年龄(57.8±10.1)岁(范围:37~79岁);肿瘤最大径(7.9±5.1)cm(范围:2.4~21.3 cm),3例有门静脉癌栓,2例有门静脉高压症。采用t检验,χ2检验或Fisher确切概率法比较两组患者术前基线资料、手术时间、出血量、术后肝功能、并发症等。结果两组患者的手术均顺利完成。与超声刀组相比,镊夹组的手术时间明显缩短[(219.3±76.4)min比(294.0±100.8)min,t=-3.322,P=0.002],出血量少[250(475)ml比500(1050)ml,t=-2.307,P=0.026],输浓缩红细胞量少[0.92(0.88)U比2.32(4.00)U,Z=-1.987,P=0.047],术后血清白蛋白水平更高[术后第1天:(33.5±6.1)g/L比(29.5±4.2)g/L,t=3.226,P=0.020;术后第3天:(35.7±4.5)g/L比(30.1±3.2)g/L,t=5.575,P<0.01;术后第7天:(33.2±3.7)g/L比(31.0±4.4)g/L,t=3.020,P=0.004]。两组患者术后血清ALT、总胆红素和凝血酶原时间的差异均无统计学意义(P值均>0.05)。镊夹组术后出现并发症8例(25.0%),其中肝功能衰竭1例;超声刀组术后出现并发症11例(35.5%),其中肝功能衰竭2例,两组术后均未出现胆瘘(P>0.05)。结论双极电凝镊夹肝脏离断技术离断肝脏的速度较快,术中出血量少。
Objective To investigate the clinical value of the bipolar tweezers-clamp for the hepatic parenchymal transection in the resection of hepatocellular carcinoma.Methods From January 2020 to January 2021,63 patients with the hepatocellular carcinoma for hepatectomy at Department of Hepatopancreatobiliary Surgery,Yuebei People′s Hospital Affiliated to Shantou University Medical College were analyzed retrospectively.According to the different instruments used in the hepatic parenchymal transection,the patients were divided into bipolar tweezers-clamp group and ultrasonic scalpel group.There were 32 patients in bipolar tweezers-clamp group,with age of(55.5±10.5)years(range:37 to 78 years),including 22 males and 10 females,tumor size was(6.0±3.4)cm(range:2.4 to 13.4 cm).There were 6 patients with portal vein tumor thrombus and 5 patients with portal hypertension.There were 31 patients in ultrasonic scalpel group,with aged(57.8±10.1)years(range:37 to 79 years),including 27males and 4 females,tumor size was(7.9±5.1)cm(range:2.4 to 21.3 cm),3 patients with portal vein tumor thrombus and 2 patients with portal hypertension.The preoperative baseline data,operation time,blood loss,postoperative liver function and the complications were compared between two groups using t test,χ^(2) test and Fisher exact probabilityrespectively.Results The operation was successfully completed in both groups.Compared with the ultrasonic scalpel group,the operation time was significantly shorter((219.3±76.4)minutes vs.(294.0±100.8)minutes,t=-3.322,P=0.002),the blood loss was less((250(475)ml vs.500(1050)ml,t=-2.307,P=0.026),the concentrate red blood cells transfusion volume was less(0.92(0.88)U vs.2.32(4.00)U,Z=-1.987,P=0.047)in the bipolar tweezers-clamp group.The postoperative serum ALB level was higher in the bipolar tweezers-clamp group than that in the ultrasonic scalpel group((33.5±6.1)g/L vs.(29.5±4.2)g/L,t=3.226,P=0.020)on postoperative day 1;((35.7±4.5)g/L vs.(30.1±3.2)g/L,t=5.575,P<0.01)on postoperative day 3;((33.2±3.7)g
作者
彭淑牖
黄从云
朱剑华
吴黎明
刘文瑛
谭勇
欧阳再兴
宋灏
Peng Shuyou;Huang Congyun;Zhu Jianhua;Wu Liming;Liu Wenying;Tan Yong;Ouyang Zaixing;Song Hao(Department of General Surgery,the Second Affiliate Hospital,Zhejiang University Medical School,Hangzhou 310009,China;Department of Hepatobiliary Surgery,Yuebei People′s Hospital Affiliated to Shantou University Medical College,Shaoguan 512026,China)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2022年第5期449-453,共5页
Chinese Journal of Surgery
关键词
肝肿瘤
肝切除术
镊夹电凝
超声刀
手术时间
出血量
Liver neoplasms
Hepatectomy
Bipolar tweezers-clamp
Ultrasonic scalpel
Operative time
Blood loss
