射频止血切割器在肝切除术中的临床应用

Clinical application of frequency hematischesis cutter in liver resection

目的探讨射频止血切割器在肝切除术中的临床应用。方法选取于2014年5月至2015年5月于本院行肝切除术治疗的患者102例,随机分为观察组和对照组,每组51例。观察组患者术中应用Habib4X射频止血切割器切肝,对照组患者术中应用传统钳夹法切肝。比较两组患者术中出血量、手术时间、肝功能变化、腹腔引流量、无瘤生存率和总生存率。结果观察组患者术中出血量少、手术时间短,与对照组相比,差异有统计学意义(t值分别为-14.88、-19.34,P均<0.001)。观察组患者术中行肝门阻断及输血的比例显著低于对照组,差异有统计学意义(t值分别为29.99、28.03,P均<0.001);观察组患者术后3天的ALT和TBil、术后24小时腹腔引流量及住院时间均显著低于对照组(t值分别为-26.98、-16.38、-15.46和-9.33,P均<0.001)。两组患者术后住院费用差异无统计学意义(t值为1.38,P值为0.17)。结论射频止血切割器应用于肝切除术可降低患者术中输血的比例,减少术中出血量及肝功能损伤,提高无瘤生存率,具有临床推广价值。

Objective To investigate the clinical application of frequency hematischesis cutter in liver resection. Methods Total of 102 cases who underwent liver resection surgery in our hospital from May 2014 to May 2015 were selected and randomly divided into observation group and control group, with 51 cases in each group. Liver resection was carried out with Habib 4X frequency hematischesis cutter in observation group and with traditional clamp in control group. Some indexes were compared including the volume of bleeding, obstructive time of portal vein during operation, change of liver function, volume of peritoneal drainage after operation, disease free survival （DFS） and overall survival （OS） of patients. Results The observation group was obviously better than the control group, which showed less bleeding amount （t = -14.88, P 〈 0.001）, shorter operation time （t = -19.34, P 〈 0.001）, lower ratio of blood transfusion and hepatic portal occlusion patients during operation （t = 29.99, 28.03, P 〈 0.001）. The levels of ALT and TBil in observation group were significantly lower than those in control group on the third day after surgery （t = -26.98, -16.38, P 〈 0.001）. The volume of peritoneal drainage at 24 h after surgery was lower and hospital stays was shorter in observation group than those in the control group （t = -15.46, -9.33, P 〈 0.001）. There was no significant difference between the two groups in the complications and the total cost of hospitalization （t = 4.33, 1.38, P = 0.04, 0.17）. Conclusions The application of radio frequency hemostasis and cutting auxiliary equipment in liver resection can reduce the ratio of blood transfusion and the amount of bleeding during operation, as well as the damage of liver function. It should contribute to improving the disease-free survival of patients.