微波刀在规则性肝切除术中的应用

Application of microwave coagulation in anatomical hepatectomy

目的探讨微波刀在规则性肝切除术中的应用价值。方法回顾性分析我院2009年1月至2012年6月所施行的341次肝切除术的临床资料。将符合研究条件的128例患者分为微波刀组(66例)与传统方法组(62例,借助于基本的手术器械),并对两组比较分析。结果围手术期无死亡病例。术中肝离断时间(开始沿预切除线分离肝组织至整个预切除部分完全脱离残肝的时间)、肝离断时出血量、术中输注红细胞量、术后第3天和第5天ALT在两组之间有统计学差异(P<0.05)。微波刀组的肝离断时间平均(61±31)min,肝离断时出血量平均(245±102)mL,术后肝功能一直为Child-Turcotte-Pugh(CTP)A级的有6.7%,其余肝功能均有波动,平均(4.3±3.8)d恢复为A级。术后出现胆漏2例,无经肝断面大出血病例。结论微波刀在规则性肝切除术中的应用是可行的、安全的。在掌握传统方法切肝的基础上,熟练使用微波刀,可使手术的质量提高。

Objective To explore application of microwave coagulation in anatomical hepatectomy. Methotis The clinical data of 341 times in patients undergoing anatomical hepatectomy between Jan. 2009 and Jun. 2012 in our hospital were studied retrospectively. A total of 128 cases met research criteria were divided into two groups and were comparatively analyzed between each other： group of microwave coagulation technique （66 cases） and group of conventional surgical technique （utilization of fundamental surgical instruments, 62 cases）. Results There were no mortality perioperatively. Duration time of liver transection, blood loss of liver transection, blood transfusion in operation, postoperative alanine aminotransferase （ALT） in the third and fifth day were significant between the two groups based on univariate analysis （P〈0.05）. In microwave group, average duration time of liver transection was （61 5：31） min with average blood loss （245 ＋ 102） mL, CTP A was 6.7% postoperatively, others recovered in small fluctuation of CTP after average 4 d （0-12 d） approximately. There was no case with large haemorrhage cross liver section, but two with biliary fistula postoperatively. Conclusion Application of microwave tissue coagulator in anatomical hepatectomy in patients is easible and safe, and proficient skills make hepatectomy quality be improved based on mastering conventional surgical technique in anatomical hepatectomy.