专题研究(Monographic Study)

大功率高频电刀在肝细胞癌肝切除术中的应用

Published at: 2017年第26卷第1期

白涛 1 , 李自慧 1 , 叶甲舟 1 , 陈洁 1 , 邹岭 1 , 朱少亮 1 , 吴宗权 1 , 杨天波 1 , 齐鲁楠 1 , 黎乐群 1 , 吴飞翔 1
1 广西医科大学附属肿瘤医院 肝胆外科/广西肝癌诊疗工程技术研究中心/区域性高发肿瘤早期防治研究广西重点实验室,广西 南宁 530021
通讯作者 飞翔 吴 Email: wufx2013@163.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2017.01.006
基金:
区域性高发肿瘤早期防治研究广西重点实验室 GKZ201604
广西壮族自治区卫生和计划生育委员会重点课题基金资助项目 S201513

摘要

目的:探讨高频电刀在肝细胞癌(HCC)肝切除术中的应用价值。方法:将386例HCC患者分为观察组(n=199)和对照组(n=187),观察组采用120 W电凝输出功率电刀进行肝切除术,对照组采用钳夹法加超声刀肝切除。比较两组术中肝门阻断时间、手术时长、术中出血量、术中及术后输红细胞情况及术后引流、肝功能改变、术后并发症、术后住院时间等指标。结果:所有患者均顺利完成手术,观察组术中未出现因大功率高频电流引起的灼伤、心电异常等。与对照组比较,观察组手术时间(192.79 min vs. 212.10 min)、肝门阻断时间(5.17 min vs. 14.65 min)、术后并发症发生率(21.1% vs. 34.2%)、术后红细胞输注率(25.7% vs. 36.7%)、术后住院时间(8.87 d vs. 12.15 d)均明显减少(均P<0.05),但术中出血量(378.56 mL vs. 412.75 mL)、术中红细胞输注率(7.5% vs. 7.5%)、术后拔管时间(5.83 d vs. 6.29 d)无统计学差异(P>0.05);观察组术后1、3 d部分肝功能指标优于对照组(均P<0.05)。两组术后1、2、3年总生存率差异均无统计学意义(均P>0.05)。结论:大功率高频电刀用于HCC肝切除术切肝速度快、止血效果好,使用安全可靠。


Application of high frequency electric knife in liver resection for hepatocellular carcinoma

Abstract

Objective: To investigate the application value of high frequency electric knife in liver resection for hepatocellular carcinoma (HCC). Methods: A total of 386 HCC patients were divided into observation group (n=199) and control group (n=187). Liver resection was performed by electric coagulation knife with an output power of 120 W in patients in observation group, and was performed by ultrasonic knife through clamp crushing method in control group. The clinical variables that included time of hepatic inflow occlusion, operative time, intraoperative blood loss, intra- and post-operative transfusion of red blood cells (RBC), postoperative drainage, changes in liver function, postoperative complications, and length of hospital stay were compared between the two groups. Results: Operation was successfully performed in all patients, and no burn injuries or electrocardiographic abnormalities caused by high-power and high-frequency current were noted in observation group. In observation group compared with control group, the operative time (192.79 min vs. 212.10 min), hepatic inflow occlusion time (5.17 min vs. 14.65 min), incidence of postoperative complications (21.1% vs. 34.2%), ratio of postoperative RBC transfusion (25.7% vs. 36.7%) and length of postoperative hospital stay (8.87 d vs. 12.15 d) were all significantly reduced (all P<0.05), but the intraoperative blood loss (378.56 mL vs. 412.75 mL), ratio of intraoperative RBC transfusion (7.5% vs. 7.5%), and time to postoperative tube removal (5.83 d vs. 6.29 d) showed no significant difference (all P>0.05). Some liver function parameters on postoperative day 1 and 3 in observation group were superior to those in control group (all P<0.05). There was no significant difference in postoperative 1-, 2- and 3-year overall survival rates between the two groups (all P>0.05). Conclusion: Using high-frequency electric knife in liver resection for HCC has fast speed of resection and good hemostatic effect, and its use is safe and reliable.


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引用本文: 涛 白, 自慧 李, 甲舟 叶, 洁 陈, 岭 邹, 少亮 朱, 宗权 吴, 天波 杨, 鲁楠 齐, 乐群 黎, 飞翔 吴. 大功率高频电刀在肝细胞癌肝切除术中的应用 [J]. 中国普通外科杂志, 2017, 26(1): 31-36.
Cite this article as: BAI Tao, LI Zihui, YE Jiazhou, CHEN Jie, ZOU Ling, ZHU Shaoliang, WU Zongquan, YANG Tianbo, QI Lunan, LI Lequn, WU Feixiang . Application of high frequency electric knife in liver resection for hepatocellular carcinoma [J]. Chin J Gen Surg, 2017, 26(1): 31-36.