大功率高频电刀在肝切除术中的应用

Application of high-power hypercator in liver resection

目的:研究大功率高频电刀在肝切除术中的应用.方法:77例肝切除患者分为两组:大功率组(n=32)和小功率组(n=45).大功率组采用120 W电凝输出功率高频电刀进行肝切除术,小功率组采用钳夹法加60 W电凝输出功率高频电刀进行肝切除术.比较两组术中肝门阻断时间、手术时间、出血及术后引流、肝功能、并发症、术后住院时间及转归等指标.结果:大功率电刀切肝时,肝断面组织迅速凝固、碳化,肝断面基本没有出血或漏胆;小功率电刀切肝时,肝断面渗血较多.大功率组和小功率组肝门阻断时间(18.13 min±4.38 minvs 20.69 min±4.32 min)、手术时间(2.43 h±0.71 h vs 2.88 h±0.83 h)、术中出血量(454.28mL±223.24 mL vs 582.89 mL±226.01 mL)比较,大功率组皆显著低于小功率组(P<0.05)但两组术中输血例数及输血量比较无统计学意义(P>0.05).术后第1天引流量(大功率组133.69 mL±71.69 mL vs小功率组196.64 mL±94.20 mL)比较,大功率组显著少于小功率组(P<0.05);两组术后第2、3天引流量比较无统计学意义(P>0.05).两组引流管放置时间、T≥39℃例数、全身炎症反应综合症例数、术后丙氨酸氨基转移酶及并发症等比较皆无统计学意义(P>0.05).术后住院时间大功率组(9.84 d±2.75 d)显著小于小功率组(11.53 d±3.86 d)(P<0.05).结论:大功率电刀切肝速度快,止血效果好,使用简单、方便、安全.

AIM： To compare the clinical effects betweenhigh-power and low-power hypercators in liverresection.METHODS： Seventy-seven patients undergo-ing liver resection were divided into either ahigh-power（HP） group（n = 32） or a low-power（LP） group（n = 45） according to the power ofhypercators used.Patients in the HP group wereoperated on using hypercators with a power of120 Watt,while the hypercators used in the LPgroup had a power of 60 Watt.Parameters weredetermined and compared between the twogroups,including time to occlusion of hepaticinflow,operative duration,intraoperative bloodloss and blood transfusion,drainage volumes,postoperative liver function,complications andpostoperative hospital stay.RESULTS： Compared with low-power hyper-cators,high-power hypercators induced moresignificant coagulative necrosis on the liver cut-ting surfaces,which therefore led to less bleed-ing and made the operations easier.In the HPgroup,the time to occlusion of hepatic inflow,operative duration,intraoperative blood lossand drainage volume（day 1） were significantlyless than those in the LP group（18.13 min ± 4.38 min vs 20.69 min ± 4.32 min,2.43 h ± 0.71 h vs2.88 h ± 0.83 h,454.28 mL ± 223.24 mL vs 582.89 mL ± 226.01 mL,133.69 mL ± 71.69 mL vs 196.64 mL ± 94.20 mL,P〈0.05 for all）.There were noremarkable differences between the two groupsin blood transfusion,drainage volumes（days 2and 3）,postoperative liver function or compli-cations.Postoperative hospital stay was signifi-cantly shorter in the HP group than in the LPgroup（9.84 d ± 2.75 d vs 11.53 d ± 3.86 d,P〈0.05）.There were no severe complications,suchas hemorrhage,liver function failure or opera-tive death,in both groups.CONCLUSION： High-power hypercator is a use-ful instrument for liver resection because of itsrapid cutting of hepatic tissue and satisfactoryhaemostatic effects on the liver cutting surfaces.