CAJ | 학술논문

目的：比较超声吸引刀（CUSA）联合高频电刀与超声刀在肝切除术中的安全性。方法回顾性分析2011年1月至2014年1月在中山大学孙逸仙纪念医院采用CUSA联合高频电刀或超声刀行肝切除术的102例患者临床资料。根据手术方式将患者分为CUSA联合高频电刀切肝组（CUSA组，53例）和超声刀切肝组（超声刀组，49例）。其中CUSA组中，男32例，女21例；平均年龄（48±11）岁。超声刀组中，男31例，女18例；年龄（49±13）岁。所有患者均签署知情同意书，符合医学伦理学规定。患者术中均采用选择性肝门阻断法阻断肝门。观察两组患者选择性肝门阻断时间、术中出血量、术后并发症等临床指标。两组观察指标比较采用t检验或χ2检验。结果 CUSA组选择性肝门阻断时间为（13±2）min，明显短于超声刀组的（23±3）min（t=-19.946，P<0.05）。CUSA组术中出血量为（293±53）ml，明显少于超声刀组的（468±54）ml（t=-16.510，P<0.05）。CUSA组胆漏发生率为4%（2/53），明显低于超声刀组的16%（8/49）（χ2=4.537，P<0.05）。结论与超声刀相比， CUSA联合高频电刀肝切除术中出血量更少，选择性肝门阻断时间更短，胆漏发生率更低，肝切除术的安全性明显提高。
목적：비교초성흡인도（CUSA）연합고빈전도여초성도재간절제술중적안전성。방법회고성분석2011년1월지2014년1월재중산대학손일선기념의원채용CUSA연합고빈전도혹초성도행간절제술적102례환자림상자료。근거수술방식장환자분위CUSA연합고빈전도절간조（CUSA조，53례）화초성도절간조（초성도조，49례）。기중CUSA조중，남32례，녀21례；평균년령（48±11）세。초성도조중，남31례，녀18례；년령（49±13）세。소유환자균첨서지정동의서，부합의학윤리학규정。환자술중균채용선택성간문조단법조단간문。관찰량조환자선택성간문조단시간、술중출혈량、술후병발증등림상지표。량조관찰지표비교채용t검험혹χ2검험。결과 CUSA조선택성간문조단시간위（13±2）min，명현단우초성도조적（23±3）min（t=-19.946，P<0.05）。CUSA조술중출혈량위（293±53）ml，명현소우초성도조적（468±54）ml（t=-16.510，P<0.05）。CUSA조담루발생솔위4%（2/53），명현저우초성도조적16%（8/49）（χ2=4.537，P<0.05）。결론여초성도상비， CUSA연합고빈전도간절제술중출혈량경소，선택성간문조단시간경단，담루발생솔경저，간절제술적안전성명현제고。
ObjectiveTo compare the safety of cavitron ultrasonic surgical aspirator (CUSA) combined with high-frequency electrotome versus harmonic scalpel in hepatectomy.MethodsClinical data of 102 patients undergoing hepatectomy using CUSA combined with high-frequency electrotome or harmonic scalpel in Sun Yat-sen Memorial Hospital of Sun Yat-sen University between January 2011 and January 2014 were retrospectively studied. The patients were divided into the hepatectomy using CUSA combined with high-frequency electrotome group (the CUSA group,n=53) and the hepatectomy using harmonic scalpel group (the harmonic scalpel group,n=49). In the CUSA group, 32 were males and 21 were females with the average age of (48±11) years old. In the harmonic scalpel group, 31 were males and 18 were females withthe average age of (49±13) years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. Porta hepatis was occluded by selective porta hepatis exclusion during hepatectomy. The interval of selective portal hepatis exclusion, intraoperative blood loss and postoperative complications of the two groups were observed. The observation indexes of the two groups were compared usingttest or Chi-square test.ResultsThe interval of selective portal hepatis exclusion of the CUSA group was (13±2) min, which was signiifcantly shorter than (23±3) min of the harmonic scalpel group (t=-19.946, P<0.05). The intraoperative blood loss of the CUSA group was (293±53) ml, which was signiifcantly less than (468±54) ml of harmonic scalpel group (t=-16.510,P<0.05). The incidence of biliary leakage of the CUSA group was 4% (2/53), which was signiifcantly lower than 16% (8/49) of the harmonic scalpel group (χ2=4.537, P<0.05).ConclusionsCompared with harmonic scalpel, CUSA combined high-frequency electrotome in hepatectomy has the advantages of less intraoperative blood loss, shorter interval of selective portal hepatis exclusion and lower incidence of biliary leakage. Thus, the safety of hepatectomy is enhanced signiifcantly.