射频凝固器在规则性肝切除术中的应用

Application of radiofrequency ablation in anatomical hepatectomy

目的探讨射频凝固器在规则性肝切除术中的应用价值。方法回顾性分析唐都医院2010年7月至2013年5月用射频凝固器所施行的57例规则性肝切除患者的临床资料（射频凝固组）。从肝切除数据库中选择病例资料形成配对组（传统钳夹组），并对2组对比分析。结果围手术期无死亡病例。射频凝固组患者术中肝离断时间、肝离断时出血量、术中输注红细胞量、阻断第一肝门、术后第3天和第5天ALT分别为（65±30）rain、（195±107）ml、（150±80）ml、7例（12．3％）、（309±226）U/L和（164±82）U/L，与传统钳夹组的（50±40）min、（255±180）ml、（205±120）ml、45例（78．9％）、（388±174）U/L和（220±156）U／L比较，差异有统计学意义（分别t=2．266、-2．158、-2．880，χ^2=51．060，t=-2．090、-2．403，均P〈0．05）。射频凝固组术中电极针误刺较大血管（管径37mm）7次，均为肝静脉分支，术后出现2例胆漏，无经肝断面大出血病例。术中、术后未发生因热凝固形成的血栓并发症。射频凝固组均未行残肝断面的对拢缝合，有7例阻断第一肝门，均为半肝切除的患者。结论射频凝固肝切除欠精细，对于重要结构的解剖，不宜使用射频凝固器。处理靠近第二肝门的较大肝静脉分支时（管径37mm），因为其可能导致血管内血栓形成，也不宜使用射频凝固器。

Objective To evaluate radiofrequency ablation in anatomical hepatectomy. Methods The clinical data of 57 patients undergoing anatomical hepateetomy with radiofrequency ablation （radiofrequeney ablation group） from Jul 2010 to May 2013 in Tangdu Hospital were compared with those 57 cases using traditional clamp crushing resection during the same period. Results There was no mortality perioperatively. Intraoperative duration of liver dissection, haemorrhage volume of liver dissection, blood transfusion volume, Pringle manoeuvre, postoperative alanine aminotransferase （ALT） in the third and fifth day in the radiofrequency ablation group were （65 ± 30） min, （195 ± 107） ml, （150 ± 80） ml, 7 cases （ 12. 3 % ）, （ 309 ± 226 ） U/L and （ 164 ± 82 ） U/L respectively, which were statistically different from those of （50 ±40） min, （255 ± 180） ml, （205 ± 120） ml, 45 （78.9%）, （388 ±174） U/L and （220 ~ 156） U/L in clamp crushing resection group （seperately t = 2. 266, - 2. 158, - 2. 880, X^2 = 51. 060, t = - 2. 090, - 2. 403, all P 〈 0. 05 ）. Large branches of hepatic vein （ caliber I〉 7 mm） were injuried by mistake 7 times in radiofrequency group, there was no massive blood loss. Postoperative biliary fistula developed in two cases. There was no ablation included thrombus. In radiofrequency group, and Pringle manoeuvre was used in hemihepatic resection in 7 patients. Conclusions Radiofrequency ablation is not recommended to dissecting large caliber vessels （ ≥ 7 mm） for fear of causing thrombus. Radiofrequeney ablation in anatomical hepateetomy, when used properly, is safe and effective.