超声吸引刀联合双极电凝与射频凝血器肝切除术的临床比较

Cut-ultrasound aspiration combined with bipolar electric coagulation vs radiofrequency coagulation device in liver resection: a clinical comparison

目的探讨超声吸引刀（cut-ultrasound aspiration,CUSA）联合双极电凝与射频凝血器（radiofrequency coagulation device,RFA）行肝切除术的临床应用效果。方法回顾性分析我院2012年1月至2013年12月期间肝胆外科治疗的108例肝切除术患者的临床资料,根据术中采用断肝方式不同分为两组：射频凝血器组（RFA组）55例和超声吸引刀联合双极电凝组（CUSA组）53例。比较两组肝门阻断率、手术时间、术中出血量、输血率、术后肝功能、术后并发症发生率、术后住院时间的差异,进行分析评价。结果两组患者围术期均无死亡病例;射频凝血器切肝肝断面形成1.5~2 cm的消融凝固带,而超声吸引刀联合双极电凝切肝肝断面损伤厚约0.5 cm肝组织。与CUSA组比较,射频凝血器组肝门阻断率低、手术时间短、术中出血少、输血率低（P〈0.05）。两组术后肝功能、并发症发生率、术后住院时间差异无统计学意义（P〉0.05）。结论应用射频凝血器与超声吸引刀联合双极电凝行肝脏切除都是安全有效的,可根据各自优缺点选择应用。

Objective To compare the advantages and disadvantages of cut-ultrasound aspiration（ CUSA） combined with bipolar electric coagulation with radiofrequency coagulation in liver resection.Methods Clinical data of 108 patients who received liver resection in our hospital from January 2012 to December 2013 were collected and retrospectively analyzed. These patients were treated by CUSA combined with bipolar electric coagulation（ CUSA group,n = 53） or radiofrequency coagulation（ RFA group,n = 55）.The portal vein blocking rate,operation time,intraoperative blood loss,blood transfusion rate,postoperative liver function,postoperative complications and postoperative hospitalization duration were compared between the 2 groups. The measured data were analyzed by student＇s t test,and the enumeration data were analyzed by Chi-squan test. Results No patient died during the operation. The radiofrequency coagulation formed a melting solidification in 1. 5 to 2 cm in liver resection,however,the thickness of liver tissue damage section was about 0. 5 cm by CUSA in liver resection. The portal vein blocking rate,operation time,intraoperative blood loss,and blood transfusion rate of the RFA group were significantly lower than those of the CUSA group（ P〈 0. 05）. There were no differences in the postoperative liver function,postoperative complications and postoperative hospitalization duration between the 2 groups（ P〉 0. 05）. Conclusion Application of the radiofrequency coagulation and CUSA in liver resection is safe and effective. But each has its advantages and disadvantages.