单用双极电凝断肝法与钳夹法在肝蒂横断法肝切除术中的比较

Comparison between Bipolar Coagulation and Classical Clump Crushing Technique in Hepatectomy with Glisson's Pedicle Transection Method

目的通过与经典的钳夹法断肝比较,探讨单用双极电凝断肝法在肝蒂横断法肝切除术中的临床价值。方法收集101例行肝蒂横断法肝切除术的原发性肝癌患者的临床资料。依据术中离断肝实质方法的不同,分为钳夹法组及双极电凝组。对比分析两组患者临床资料的差异。结果两组患者术前Child-Pugh分级、吲哚菁绿15 min清除率(indocyanine green clearance rate at 15min,ICGR15)、合并肝硬化情况及手术时间差异无统计学意义(P>0.05)。两组患者的手术出血量[(488.89±268.76)ml vs.(390.00±209.82)ml,P=0.041)]、术中输血率(25.92%vs.8.51%,P=0.023)、术后第一日白蛋白(albumin,ALB)水平[(25.69±4.27)ml vs.(27.57±4.11)ml,P=0.026]及术后24 h腹引量[60.00(10.00,135.00)ml vs.50.00(30.00,80.00)ml P=0.039]间差异有统计学意义。结论单独使用双极电凝断肝能够减少肝蒂横断法肝切除术出血量,降低输血率,术后白蛋白水平更高,渗出更少。单用双极电凝断肝应用于肝蒂横断法肝切除术较传统钳夹法断肝更有优势,具有临床推广价值。

Objective To evaluate the application of bipolar coagulation in hepatectomy with Glisson’s pedicle transection method by comparing the efficacy of bipolar coagulation alone and classical clump crushing technique. Methods We collected clinical data of 101 primary hepatic carcinoma patients who received hepatectomy with Glisson’s pedicle transection method. According to the use of bipolar coagulation, it was differed into bipolar coagulation alone group and clamp crushing technique group. Clinical details between two groups were compared. Results The two groups were similar in Child-Pugh classification, indocyanine green clearance rate at 15minutes(ICGR15), liver sclerosis, and operation time(P>0.05). There were significance differences in bleeding amount[(488.89±268.76) vs.(390.00±209.82)ml, P=0.041], blood transfusion rate(25.92% vs. 8.51%, P=0.023), serum albumin in the first postoperative day[(25.69±4.27) vs.(27.57±4.11)ml, P=0.026] and peritoneal drainage amount in 24 h after operation[60.00(10.00, 135.00) vs. 50.00(30.00, 80.00)ml P=0.039]. Conclusion Compared with classical clump crushing technique, the application of bipolar coagulation in hepatectomy with Glisson’s pedicle transection method is helpful in decreasing bleeding amount and blood transfusion rate, and patients have a higher serum albumin after operation.