肝创面对拢缝合与创面敞开短期临床结局的对比研究

Comparative study of short-term clinical outcome of hepatic cutting surface by suture and open management

目的对比肝断面对拢缝合与创面敞开的短期临床结局,以更好地进行肝创面的临床处理。方法回顾性分析本院2013年1月至2014年1月66例肝切除术患者的临床资料,其中44例行对拢缝合(对拢缝合组),22例行创面敞开(创面敞开组)。比较两组患者的短期临床结局。结果对拢缝合组手术时间明显短于创面敞开组[(128.43±25.78)min vs(155.16±10.21)min,t=4.379,P=0.04]。对拢缝合组术后第1、2天的腹腔引流量均少于创面敞开组(P=0.01、0.03)。对拢缝合组术后第1、3天谷丙氨酶(ALT)、血清总胆红素(TBIL)水平均高于创面敞开组(ALT:P=0.02、0.04;TBIL:P=0.04、0.03),对拢缝合组术后第1、3天白蛋白(Alb)明显低于创面敞开组(P=0.04、0.04),术后第5天ALT、TBIL、Alb情况两组比较差异无统计学意义。两组术中出血量(P=0.17)、肝门阻断时间(P=0.25)差异无统计学意义。结论针对肝创面的处理,因为创面敞开对组织损伤是最小的,所以创面敞开应该被临床推荐。

Objective To compare the short-term clinical outcome of hepatic cutting surface by suture and open management. Methods The clinical data of sixty-six patients underwent hepatectomy from January 2013 to January 2014 in our hospital were analyzed, with 44 by suture and 22 open management, re-spectively. Results Operation time of the suture group was shorter than the open group[（128.43 ±25.78） min vs（155.16 ±10.21） min, t =4.379, P =0.04）; postoperative day 1 and day 2 abdominal drainage of the suture group was less than the other group（P=0.01, 0.03）. ALT and TBIL of the suture group 1- and 3-day after operation was higher than open group（ALT： P=0.02, 0.04; TBIL： P=0.04, 0.03）. The level of Alb of the suture group after operation was lower than the open group（P=0.04, 0.04）. There were no significant differences of the amount of bleeding（P=0.17） and the time of hepatic portal blocking（P=0.25） during operation between the two groups. Conclusion The open management of hepatic cutting surface can be clinically proposed due to less tissue trauma.