射频消融在严重肝破裂术中的应用价值分析

Application value of radiofrequency ablation in severe hepatorrhexis

目的探讨射频消融在严重肝破裂术中的应用价值和安全性。方法回顾性分析2016年1月至2018年10月在我院因严重肝破裂(Ⅲ、Ⅳ、Ⅴ级)手术治疗的24例患者临床资料。根据是否应用射频消融止血分为常规组15例和射频组9例。观察两组患者术中出血量、肝门阻断时间、围手术期肝功能恢复情况及并发症发生情况等。结果与常规组对比:射频组肝门阻断时间显著缩短[(38.5±8.42)min vs(15.6±4.91)min,P<0.05],术中出血显著减少[(820±364)mL vs(459±322)mL,P<0.05];术后第3天血清ALT显著降低(562±243)U/L vs(319±124)U/L,AST显著降低(426±126)U/L vs(304±82)U/L,术后第3天其他肝功能指标及术后第1天及术后第7天各项肝功能指标比较的差异无统计学意义;术后胆漏、再出血、胸腔积液、腹腔感染等并发症发生率比较的差异亦无统计学意义。结论在Ⅳ、Ⅴ级肝破裂手术中应用射频消融止血可以缩短肝门阻断时间,减少术中出血,有利于早期肝功能恢复,是一种安全、有效的方法。

Objective To investigate the value and safety of radiofrequency ablation in severe liver rupture. Methods To conduct retrospective analysis of the clinical data of 24 patients with severe liver rupture (grade Ⅲ,Ⅳ and Ⅴ) who were treated in No. 900 Hospital of the Logistic Support Forces between January 2016 to October 2018. The patients were divided into routine group (15 cases) and radiofrequency group (9 cases) according to whether radiofrequency ablation was used for hemostasis. To observe the amount of bleeding in operation, the time of hepatic hilus occlusion, the recovery of liver function and the occurrence of complications in perioperative period of the two groups of patients. Results Compared with the routine group, the time of hepatic hilus occlusion of the radiofrequency group was significantly shortened [(38. 5±8. 42) min vs (15. 6±4.91) min, P〈0. 05],and the intraoperative bleeding was significantly decreased [(820±364) mL w (459±322) mL,P<0. 05]. On the third day after operation, the serum ALT decreased significantly (562±243) U/L vs (319±124) U/L and the AST obviously decreased (426±126) U/L vs (304±82) U/L. There was no statistical significance in difference between other liver function indexes on the third day after operation and liver function indexes on the first day and the seventh day after operation. There was also no statistical significance in complications such as bile leakage,rebleeding,pleural effusion? abdominal cavity infection and so on after operation. Conclusion Applying radiofrequency ablation for hemostasis in grade IV and V hepatic rupture operation is a safe and effective method, which can shorten the time of hepatic hilus occlusion,reduce intraoperative bleeding,and facilitate the early recovery of liver function.