双极电凝与超声刀在腹腔镜肝切除术中使用体会

Application of bipolar coagulation and ultrasound knife in laparoscopic hepatectomy

目的探讨双极电凝与超声刀在腹腔镜肝切除术中的使用价值。方法选择40例实施腹腔镜下肝叶切除术的患者,其中20例使用双极电凝与超声刀断离肝脏,20例使用单极电凝断离肝脏,比较两组患者离断肝脏所耗时间、离断肝脏时出血及术后肛门排气时间,并统计两组发生的并发症。结果观察组离断肝脏所耗时间少于对照组(P<0.05),离断肝脏时出血少于对照组(P<0.05),术后肛门排气时间为(3.4±0.5)d,与对照组(4.1±0.8)d相比,差异无统计学意义(P>0.05)。观察组术后出现出血1例,显著低于对照组(6例),差异具有统计学意义(P<0.05)。两组出现胆漏和腹腔感染的比率差异无统计学意义(P>0.05)。结论肝脏切除术断离肝脏切面时使用双极电凝联合超声刀进行,能有效减少肝脏表面出血,对于相对较粗的肝静脉出血亦有一定的凝固效果,有效缩短了手术时间,提高了手术效率。

Objective To explore the application value of bipolar coagulation and ultrasound knife in laparoscopic hepatectomy. Methods The 40 cases patients with laparoscopic hepatectomy, 20 cases used bipolar coagulation and ultrasound knife to break away from the liver,while other 20 cases used monopolar coagulation to break away from the liver. The time of break away from liver, amount of bleeding, postoperative exhausting time and complication were compared between two groups. Results The time of transection of liver, and amount of bleeding of the observation group were less than the control group （P〈0.05）,the postoperative exhausting time of observation group was （3.4±0.5）d, while the control group was （4.1±0.8） d,there was no significant difference between two groups （P〉0.05）.1 case happened postoperation bleeding in observation group,while 6 cases in control group,there were significant differences between two groups （P〈0.05）.The proportion of bile leakage and abdominal infection of the two groups were not significant different （P〉0.05）. Conclusion Bipolar coagulation and ultrasound knife in laparoscopic hepatectomy can effectively reduce bleeding,and have certain solidification effect in relatively coarse hepatic vein bleeding,so as to effectively shorten the operation time and improve the operation efficiency.