原发性肝癌术后膈下积液的预防和治疗

Prevention and treatment of postoperative subphrenic hydrops in patients with primary liver cancer

目的探讨原发性肝癌术后膈下积液形成的原因并总结防治经验。方法回顾性分析东方肝胆外科医院2017年7月至2018年9月接受右肝切除术的84例肝癌患者的临床资料。根据留置腹腔引流管的不同方案,分为两组:A组(n=45)采用常规引流方案,即术中采用氩气电刀游离肝脏且肝癌切除后不常规对拢缝扎膈肌创面,膈下留置双套管一根;B组(n=39)采用改良引流方案,在留置膈下双套管之外,另外留置膈下单腔管一根。比较两组肝硬化情况、肿瘤大小、肝门阻断时间以及膈下积液发生和处理情况。结果A组较B组术后膈下积液发生率及微创穿刺率明显升高[60%(27/45)vs 7.7%(3/39),48.9%(22/45)vs 5.1%(2/39),均P<0.01]。结论采用氩气电刀游离肝脏且不常规对拢缝扎膈下创面,留置双套管并附加留置膈下单腔管,能较好地预防术后膈下积液的发生;对于已形成的膈下积液,膈下穿刺放置中心静脉导管引流安全有效,患者耐受良好。

Objective To investigate the reasons for postoperative subphrenic hydrops in primary liver cancer and to summarize the prevention and treatment experiences.Methods Clinical data of 84 patients with primary liver cancer who underwent right hepatectomy from Jul.2017 to Sep.2018 in the Eastern Hepatobiliary Surgery Hospital were analyzed retrospectively.According to the different schemes of the indwelling abdominal drainage tube,patients were divided into Group A and Group B.Group A(n=45)received the conventional drainage scheme,with the liver mobilized by argon electric knife beam coagulation.The uncoventional suture of the subphrenic wound surface after hepatectomy was employed and double cannula was indwelled;Group B(n=39)received a modified drainage scheme,and were indwelled the subphrenic double cannula and a single lumen tube.Cirrhosis,tumor size,the duration of Pringle’s maneuver,as well as the occurrence and treatment of subphrenic hydrops between the two groups were compared.Results The incidence of postoperative subphrenic hydrops and minimally invasive puncture was significantly higher in group A than in group B[60%(27/45)vs 7.7%(3/39),48.9%(22/45)vs 5.1%(2/39),all P<0.01].Conclusion Mobilizing the liver by argon electric knife beam coagulation,unconventionally suturing the surface of subphrenic wound after hepatectomy,indwelling double cannula and a single lumen tube,which can prevent subphrenic hydrops.For the formed subphrenic hydrops,subphrenic puncture with central venous catheter is safe,effective and well-tolerated.