CAJ | 학술논문

目的探讨射频凝固器在规则性肝切除术中的应用价值.方法回顾性分析唐都医院2010年7月至2013年5月用射频凝固器所施行的57例规则性肝切除患者的临床资料(射频凝固组).从肝切除数据库中选择病例资料形成配对组(传统钳夹组),并对2组对比分析.结果围手术期无死亡病例.射频凝固组患者术中肝离断时间、肝离断时出血量、术中输注红细胞量、阻断第一肝门、术后第3天和第5天ALT分别为(65±30) min、(195±107) ml、(150 ±80) ml、7例(12.3％)、(309±226) U/L和(164±82) U/L,与传统钳夹组的(50 ±40) min、(255±180) ml、(205±120) ml、45例(78.9％)、(388±174) U/L和(220±156) U/L比较,差异有统计学意义(分别t=2.266、-2.158、-2.880,x2=51.060,t=-2.090、-2.403,均P＜0.05).射频凝固组术中电极针误刺较大血管(管径≥7 mm)7次,均为肝静脉分支,术后出现2例胆漏,无经肝断面大出血病例.术中、术后未发生因热凝固形成的血栓并发症.射频凝固组均未行残肝断面的对拢缝合,有7例阻断第一肝门,均为半肝切除的患者.结论射频凝固肝切除欠精细,对于重要结构的解剖,不宜使用射频凝固器.处理靠近第二肝门的较大肝静脉分支时(管径≥7 mm),因为其可能导致血管内血栓形成,也不宜使用射频凝固器.
목적 탐토사빈응고기재규칙성간절제술중적응용개치.방법 회고성분석당도의원2010년7월지2013년5월용사빈응고기소시행적57례규칙성간절제환자적림상자료(사빈응고조).종간절제수거고중선택병례자료형성배대조(전통겸협조),병대2조대비분석.결과 위수술기무사망병례.사빈응고조환자술중간리단시간、간리단시출혈량、술중수주홍세포량、조단제일간문、술후제3천화제5천ALT분별위(65±30) min、(195±107) ml、(150 ±80) ml、7례(12.3％)、(309±226) U/L화(164±82) U/L,여전통겸협조적(50 ±40) min、(255±180) ml、(205±120) ml、45례(78.9％)、(388±174) U/L화(220±156) U/L비교,차이유통계학의의(분별t=2.266、-2.158、-2.880,x2=51.060,t=-2.090、-2.403,균P＜0.05).사빈응고조술중전겁침오자교대혈관(관경≥7 mm)7차,균위간정맥분지,술후출현2례담루,무경간단면대출혈병례.술중、술후미발생인열응고형성적혈전병발증.사빈응고조균미행잔간단면적대롱봉합,유7례조단제일간문,균위반간절제적환자.결론 사빈응고간절제흠정세,대우중요결구적해부,불의사용사빈응고기.처리고근제이간문적교대간정맥분지시(관경≥7 mm),인위기가능도치혈관내혈전형성,야불의사용사빈응고기.
Objective To evaluate radiofrequency ablation in anatomical hepatectomy.Methods The clinical data of 57 patients undergoing anatomical hepatectomy with radiofrequency ablation (radiofrequency ablation group) from Jul 2010 to May 2013 in Tangdu Hospital were compared with those 57 cases using traditional clamp crushing resection during the same period.Results There was no mortality perioperatively.Intraoperative duration of liver dissection,haemorrhage volume of liver dissection,blood transfusion volume,Pringle manoeuvre,postoperative alanine aminotransferase (ALT) in the third and fifth day in the radiofrequency ablation group were (65 ±30) min,(195 ± 107) ml,(150 ±80) ml,7 cases (12.3％),(309 ±226) U/L and (164 ±82) U/L respectively,which were statistically different from those of (50 ±40) min,(255 ± 180) ml,(205 ± 120) ml,45 (78.9％),(388 ± 174) U/L and (220 ± 156) U/L in clamp crushing resection group (seperately t =2.266,-2.158,-2.880,x2 =51.060,t =-2.090,-2.403,all P ＜ 0.05).Large branches of hepatic vein (caliber ≥ 7 mm) were injuried by mistake 7 times in radiofrequency group,there was no massive blood loss.Postoperative biliary fistula developed in two cases.There was no ablation included thrombus.In radiofrequency group,and Pringle manoeuvre was used in hemihepatic resection in 7 patients.Conclusions Radiofrequency ablation is not recommended to dissecting large caliber vessels (≥ 7 mm) for fear of causing thrombus.Radiofrequency ablation in anatomical hepatectomy,when used properly,is safe and effective.