CAJ | 학술논문

目的：探讨Habib 4X射频止血切割器（Habib 4X）在肝恶性肿瘤切除术中的应用价值。方法回顾性研究2009年2月至2013年6月在广州医科大学附属肿瘤医院胃肠肿瘤外科应用Habib 4X行肝切除的75例肝恶性肿瘤患者临床资料。其中男55例，女20例；平均年龄（53±12）岁；原发性肝癌49例，继发性肝癌26例。所有患者均签署知情同意书，符合医学伦理学规定。患者采用气管插管全身麻醉，在距离肿瘤2～3 cm处采用Habib 4X沿肿瘤边缘消融后行肝切除术。观察患者术中出血、输血情况，手术时间，术后ALT、AST、TB变化，术后住院时间及并发症情况。出院后患者接受随访，观察肿瘤复发及死亡情况。结果75例肝癌患者均顺利完成手术。术中出血量为（318±89）ml，输血率为7%（5/75），手术时间中位数为104（17～191）min，术后住院时间为（11±4）d。术后1 d， ALT、AST、TB升至高峰，随后进行性下降，至术后9 d肝功能基本恢复正常。术后出现胆瘘2例，均经加强引流后治愈。原发性肝癌患者1、3年复发率分别为6%（3/49）、10%（5/49），继发性肝癌患者分别为23%（6/26）、27%（7/26）。随访期间原发性肝癌和继发性肝癌患者病死率分别为4%（2/49）、27%（7/26），原发性肝癌患者中2例死于术后肝性脑病，继发性肝癌患者中7例死于肿瘤广泛转移。结论在肝恶性肿瘤患者肝切除术中应用Habib 4X是一种安全、有效的治疗方法，有可能降低术后肿瘤复发率。
목적：탐토Habib 4X사빈지혈절할기（Habib 4X）재간악성종류절제술중적응용개치。방법회고성연구2009년2월지2013년6월재엄주의과대학부속종류의원위장종류외과응용Habib 4X행간절제적75례간악성종류환자림상자료。기중남55례，녀20례；평균년령（53±12）세；원발성간암49례，계발성간암26례。소유환자균첨서지정동의서，부합의학윤리학규정。환자채용기관삽관전신마취，재거리종류2～3 cm처채용Habib 4X연종류변연소융후행간절제술。관찰환자술중출혈、수혈정황，수술시간，술후ALT、AST、TB변화，술후주원시간급병발증정황。출원후환자접수수방，관찰종류복발급사망정황。결과75례간암환자균순리완성수술。술중출혈량위（318±89）ml，수혈솔위7%（5/75），수술시간중위수위104（17～191）min，술후주원시간위（11±4）d。술후1 d， ALT、AST、TB승지고봉，수후진행성하강，지술후9 d간공능기본회복정상。술후출현담루2례，균경가강인류후치유。원발성간암환자1、3년복발솔분별위6%（3/49）、10%（5/49），계발성간암환자분별위23%（6/26）、27%（7/26）。수방기간원발성간암화계발성간암환자병사솔분별위4%（2/49）、27%（7/26），원발성간암환자중2례사우술후간성뇌병，계발성간암환자중7례사우종류엄범전이。결론재간악성종류환자간절제술중응용Habib 4X시일충안전、유효적치료방법，유가능강저술후종류복발솔。
Objective To assess the use of bipolar radiofrequency device Habib 4X in hepatic malignant tumor resection. Methods Clinical data of 75 patients with hepatic malignant tumor undergoing hepatectomy with the use of Habib 4X in Department of Gastrointestinal Oncology, Cancer Center of Guangzhou Medical University from February 2009 to June 2013 were retrospectively analyzed. There were 55 males and 20 females with a mean age of (53±12) years old. Forty-nine cases were with primary liver cancer and 26 cases were with secondary liver cancer. The informed consents of all patients were obtained and the ethics committee approval was received. Patients received endotracheal general anesthesia. Hepatectomy was performed after tumor ablation was employed with Habib 4X device 2-3 cm away from the tumor. The intraoperative bleeding, blood transfusion, operation duration, changes of postoperative alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TB), length of postoperative hospital stay and complications were observed. Patients were followed up after being discharged from hospital and tumor recurrence and mortality were observed. Results All the 75 patients underwent hepatectomy successfully. The mean intraoperative bleeding was (318±89)ml, the rate of blood transfusion was 7%(5/75), the median of operation duration was 104 (17-191) min, the length of postoperative hospital stay was (11±4)d. ALT, AST, TB rose to a top level 1 d after operation, then went down progressively and liver function backed to normal 9 d after operation. Two cases suffered from bile ifstula and were cured after enhancing drainage. The 1-, 3-year recurrence rates were 6%(3/49), 10%(5/49) respectively in patients with primary liver cancer and were 23%(6/26), 27%(7/26) respectively in patients with secondary liver cancer. The mortality were 4%(2/49), 27%(7/26) respectively in patients with primary liver cancer and secondary liver cancer during the follow-up. Two cases with primary liver cancer died of postoperative hepatic encephalopathy and 7 cases with secondary liver cancer died of tumor widespread metastasis. Conclusions Habib 4X is safe and effective for hepatic malignant tumor resection. It may reduce the postoperative tumor recurrence rate.