微波止血分离器在降低肝门板的肝癌切除术中的应用

Application of microwave hemostatic device in hepatectomy of liver cancer with hilar plate dissection

目的探讨微波止血分离器在降低肝门板的肝癌切除手术中的临床应用价值。方法回顾分析2010年至2012年70例应用微波止血分离器进行的降低肝门板的肝癌切除手术资料,采用微波止血分离器(HeSetor)进行肝门板解剖及断肝,术中仅阻断切除侧肝门;与同期40例常规手术对照组资料进行比较,该组采用常规Pringle阻断肝门及钳夹断肝。结果两组手术均顺利完成。HeSetor结合降低肝门板组手术时间平均(115.4±42.3)min;术中出血量平均(120.0±105.2)ml,术中均无输血;术后肝功能生化检查平均在(6.3±2.7)d恢复;术后并发症发生率为15.7%(11/70),其中胸腔积液5例(7.1%),腹水6例(8.6%);术后平均住院(6.4±3.5)d。常规手术对照组手术时间平均(169.1±86.5)min;术中出血量平均(360.5±153.1)ml,术中3例输血(7.5%);术后肝功能生化检查平均在(9.1±5.6)d恢复;术后并发症发生率为30.0%(12/40),其中胸腔积液5例(15.0%),腹水5例(15.0%),胆瘘2例(7.5%);术后平均住院(11.1±6.3)d。两组间以上指标比较,P值均小于0.05。结论应用微波止血分离器进行的降低肝门板的肝癌切除手术是一种安全可靠的肝切除方法,术中出血少,容易掌握,术后恢复快,值得临床推广应用。

Objective To evaluate the applied value of microwave hemostatic device in hepatec-tomy of liver cancer with hilar plate dissection.Methods The clinical data of 70 patients with liver cancer undergoing hepatectomy with microwave hemostatic device （HeSetor）from 2010 to 2012 were retrospectively analyzed and compared with 40 patients with liver cancer undergoing conventional hepa-tectomy.The technique of focal hepatic vascular clamping with hilar plate dissection was adopted dur-ing all the operations in the group of using HeSetor.In the control group of conventional hepatectomy, traditional Pringle maneuver and clamp crushing method was adopted.Results All the hepatectomies of both groups were successfully completed.In the HeSetor group,the average operative time was 115.4±42.3 min and average intraoperative blood loss was 120±105.2 mL.No patients were given blood transfusion during operations.The liver function returned to the normal level within 6.3 ±2.7 days.The incidence rate of post-operative complications was 15.7% （11/70）,5 cases suffered from hydrothorax,and 6 cases from ascites.The mean length of postoperative hospital stay was 6.4±3.5 days.In the control group,the average operative time was 169.1±86.5 min and average intraopera-tive blood loss was 360.5±153.1 mL.Three patients were given blood transfuion during operations. The liver function returned to the normal level within 9.1±5.6 days.The incidence rate of post-oper-ative complications was 30.0% （12/40）,5 cases suffered from hydrothorax,5 cases from ascites,and 2 cases from bile leakage.The mean length of postoperative hospital stay was 11.1±6.3 days （P〈0.05）.Conclusions Microwave hemostatic device was safe and feasible in hepatectomy of liver cancer with hilar plate dissection.This technique can provide the advantages of facility with convenience,eas-ily handling and rapid recovery,which deserves further clinical applications.