单极电凝、双极电凝和氩气刀在肝细胞癌患者肝切除术中行肝创面局部止血的效果比较

Local hemostatic effects of unipolar electrocoagulation,bipolar electrocoagulation,and argon plasma coagulation on liver wounds of patients with hepatocellular carcinoma during hepatectomy:a comparative study

目的比较单极电凝、双极电凝和氩气刀在肝细胞癌患者肝切除术中行肝创面局部止血的效果。方法回顾性分析77例行肝切除术治疗的肝细胞癌患者的临床资料,根据术中肝创面局部止血方式将患者分为单极组(采用单极电凝行肝创面止血)25例、双极组(采用双极电凝行肝创面止血)26例与氩气组(采用氩等离子体凝固器行肝创面止血)26例。比较3组患者术后72 h的腹腔引流量、术后住院天数、术后出血发生率、术后胆漏发生率,以及术前和术后1 d、3 d、5 d的AST/ALT值。结果3组患者组间术后腹腔引流量、术后住院时间、术后胆漏发生率、术后出血发生率比较,差异均无统计学意义(均P>0.05),术后1 d、3 d 3组的AST/ALT比值均为单极组<双极组<氩气组(均P<0.05),而术后5 d各组间的AST/ALT比值差异均无统计学意义(均P>0.05)。结论对于肝细胞癌患者,肝切除术中采用单极电凝、双极电凝和氩气刀进行肝创面局部止血的效果相差不大,但采用氩气刀止血对患者术后短期的肝脏急性损伤最小。

Objective To compare the local hemostatic effects of unipolar electrocoagulation,bipolar electrocoagulation,and argon plasma coagulation on liver wounds of patients with hepatocellular carcinoma during hepatectomy.Methods The clinical data of 77 patients with hepatocellular carcinoma treated by hepatectomy were analyzed retrospectively.According to the local hemostatic approach for liver wounds during operation,the patients were divided into unipolar group(25 cases undergoing hemostasis of liver wounds by unipolar electrocoagulation),bipolar group(26 cases undergoing hemostasis of liver wounds by bipolar electrocoagulation)and argon group(26 cases undergoing hemostasis of liver wounds using argon plasma coagulator).A comparison was conducted among the three groups on the intraperitoneal drainage volume 72 hours after operation,postoperative hospital stay,and incidence rates of postoperative bleeding and bile leakage,as well as AST/ALT ratios preoperatively,days 1,3,and 5 postoperatively.Results There was no statistically significant difference in postoperative intraperitoneal drainage volume,postoperative hospital stay,incidence rate of postoperative bile leakage,or incidence rate of postoperative bleeding among the three groups(all P>0.05),one and three days after operation,the AST/ALT ratio increased in the sequence of the unipolar group,the bipolar group and the argon group(all P<0.05),but there was no statistically significant difference in AST/ALT ratio on day 5 postoperatively among groups(all P>0.05).Conclusion For patients with hepatocellular carcinoma,there are few differences in the efficacy of unipolar electrocoagulation,bipolar electrocoagulation and argon plasma coagulation used in hepatectomy for local hemostasis of liver wounds,but hemostasis by argon plasma coagulation has the minimum short-term acute liver injury after operation.