射频止血系统在腹腔镜肝血管瘤剥离术中的应用

Application value of radiofrequency hemostasis in laparoscopic hepatoangioma dissection

目的探讨射频止血系统在肝血管瘤剥离术中应用的可行性及效果。方法回顾性分析2016年8月至2018年3月在十堰市太和医院行腹腔镜肝血管瘤剥离术治疗的37例病人的临床资料。根据术中是否使用射频止血系统分为A、B两组,A组为利用射频止血系统行瘤体剥离(25例),B组常规使用超声刀行剥离术(12例),比较两组病人术中出血及术后恢复情况。结果两组中3例未能成功行腹腔镜肝血管瘤剥离术,中转开腹行肝血管瘤切除术(A组2例,B组1例),余均成功行腹腔镜肝血管瘤剥离术。A组手术时间较B组明显延长[(240±20)min比(198±11)min,P<0.05],术中出血量A组为(412±220)ml,B组为(550±372)ml,差异有统计学意义(P<0.05)。而两组肝门阻断时间、术后肝功能情况无明显差异;B组术后引流量为(288±62)ml,多于A组的(211±41)ml(P<0.05)。A组术后引流管拔管时间短于B组(P<0.05);术后胃肠功能恢复时间A组为(2.1±1.5)d,快于B组的(4.3±2.7)d(P<0.05)。两组病人术后未发生腹腔出血、肝衰竭及死亡。结论应用射频止血系统行肝血管瘤剥离术,能够减少术中出血及创伤,加快术后康复。

Objective To explore the feasibility and effect of radiofrequency hemostasis in hepatoangioma dissection.Methods Data of 37 patients who received laparoscopic hepatoangioma dissection in our department from August 2016 to March 2018 were selected.The patients were divided into group A and group B according to the use of the radiofrequency hemostasis system during operation.In group A,25 cases of tumor dissection were performed using the radiofrequency hemostasis system,while 12 cases were performed routinely with ultrasonic scalpel in group B,and the intraoperative hemorrhage and postoperative recovery were compared between the two groups.Results Among the two groups,3 patients failed to undergo laparoscopic hepatoangioma dissection,and the patients underwent hepatoangioma resection through laparotomy(2 patients in group A and 1 patient in group B).Operation time was(240±20)min in group A and(198±11)min in group B(P<0.05).It was significantly longer in group A than that in group B.The intraoperative blood loss was(412±220)ml in group A,(550±372)ml in group B(P<0.05),and there was a significant difference between the two groups.However,there was no significant difference in the duration of hepatic portal block and postoperative liver function between the two groups.The postoperative drainage volume in group B was higher than that in group A,which was(288±62)ml(P<0.05).The time of drainage tube extraction was shorter in group A than that in group B;Postoperative gastrointestinal function recovery time was faster in group A than group B,which was(2.1±1.5)d(P<0.05).No abdominal hemorrhage,liver failure and death occurred in the two groups.Conclusion Radiofrequency hemostasis for hepatoangioma dissection can reduce intraoperative hemorrhage and trauma and accelerate postoperative rehabilitation.