再次肝移植中应用双极电凝的临床研究

Clinical study of bipolar coagulation in liver re-transplantation

目的评估双极电凝在再次肝移植中的应用价值。方法回顾性分析天津市第一中心医院2010年3月至2017年9月所有肝移植术后受者资料,选取年龄18〜65岁远期再次原位肝移植的106例受者纳入研究,其中传统组(非双极电凝组)64例,改良组(双极电凝组)42例。通过对比分析两组间的术前供受者基本资料、术中出血量等指标和术后并发症发生情况,评价两种方法的效果。结果两组受者术前一般资料差异无统计学意义。改良组受者术中出血量、输血量均较传统组少(P<0.05)。改良组病肝切除时间和总手术时间均较传统组明显缩短(P<0.01)。两组受者术后总体并发症发生率分别为45.2%和39.1%,差异无统计学意义(P=0.528)。术后ICU停留时间相当(P=0.206),肝功能差异无统计学意义(P>0.05)。结论双极电凝显著缩短再次肝移植手术时间,减少术中出血,不增加术后并发症的发生率,它是一个可靠的、安全的手术技术。

Ohjective To evaluate the application value of bipolar coagulation during liver re-transplantation.Methods Retrospective analysis was performed for clinical data of patients undergoing liver transplantation at Tianjin First Central Hospital from 2010 to 2017.And 106 cases of orthotopic liver re transplantation aged 18~65 years were selected.They were divided into non-bipolar coagulation group(64 cases)and bipolar coagulation group(42 cases).The efficacies of two methods were evaluated by comparing preoperative,intraoperative and postoperative status between two groups.Results No significant inter group differences existed in preoperative clinical data.Intraoperative blood loss and blood transfusion volume were lower in bipolar coagulation group than those in non-bipolar coagulation group(P<0.05).Time of liver resection and total operative duration were significantly shorter in bipolar coagulation group than those in non bipolar coagulation group(P<0.01).No significant inter group difference existed in overall postoperative complication rate(45.2%vs 39,1%,P=0.528),postoperative stay time of intensive care unit(ICU,P=0.206)or liver function recovery(P>>0.05).Conclusions Bipolar coagulation significantly shortens time of re-transplantation,reduces intraoperative bleeding and does not increase the incidence of postoperative complications.The surgical technique is both reliable and safe.