肝切除术创面不同处理方法效果的临床研究  

Hemostatic effect of different managements of hepatic cutting surface in hepatectomy

作　　者：尹涛[1] 段传谊[1] 符常波[1] 汪群[1] 

机构地区：[1]湖北省肿瘤医院肝胆胰外科二病区,武汉430079

出　　处：《腹部外科》2011年第4期237-239,共3页Journal of Abdominal Surgery

摘　　要：目的研究肝切除术肝创面处理方法及其对术后肝功能恢复的影响。方法回顾性分析我科2009年10月至2010年3月因肝肿瘤行肝切除术53例的临床资料。根据创面处理方法不同分为创面敞开＋明胶海绵＋医用止血胶止血组（A组，25例），创面敞开＋微孔多聚糖止血球（MPH）止血组（B组，19例），创面对缝止血组（C组，9例）。对止血时间、术后24、48和72h腹腔引流量及术后第1、3、5天病人谷丙转氨酶（ALT）、总胆红素（TBlL）、白蛋白（Alb）变化进行对比分析。结果止血时间A组最长，且与B、C两组比较，差异有统计学意义（P〈0．01）。3组术后24、48及72h腹腔引流量B组均最少，且与A、C两组比较，差异有统计学意义（P〈0．05）。术后第1、3、5天ALT、TBIL升高幅度为C组最大，且与A、B两组比较，差异有统计学意义（P〈0．05）。3组病人术后第1天Alb值C组较A、B两组低，且差异有统计学意义（P〈0．05）。结论肝切除术后肝创面的处理方法与术后肝功能恢复有密切关系，用微孑L多聚糖止血球处理肝创面可缩短止血时间及手术时间，减少术后创面渗出，进而减轻手术对肝功能的损害，减少白蛋白补充量，有利于术后肝功能恢复。Objective To summarize the management of hepatic cutting surface in heptectomy and its influence on recovery of the liver function after operation. Methods The clinical data of 53 pa- tients with liver neoplasm receiving hepatectomy from October 2009 to March 2010 at our department were reviewed and the patients were divided into three groups according to the management of the he- patic cutting surface. The surface was open and managed with gelatin sponge and medical protein muci- lage in group A, open and cauterized with microporous polysaccharide hemospheres in group B, and sutured in group C. The hemostatsis time-consumption,the blood loss of wound surface at 24, 48, 72 h after the operations and the outcomes of hepatic function test at 1, 3, 5 days after the operations were determined and compared among the three groups. Results The hemostatsis time-consumption in group A was significantly longer than in groups B and C. The blood loss in group B was significant- ly less than in groups A and C at 24, 48, 72 h after the operations. Meanwhile, the change in ALT/TBIL was remarkably higher in group C than in groups A and group B at 1, 3, and 5 days after the operations. In the contrast, the Alb in group C was less than in groups A and I3, and the difference was more significant at the first day after the operations. Conclusion The management of hepatic cut- ting surface can directly affect blood loss and liver function. By using the mieroporous polysaccharide hemospheres we can shorten the hemostatsis time-consumption and decrease the blood loss after the operations, which is beneficial to the recovery of the liver function.

关 键 词：肝切除术 创面处理 微孔多聚糖止血球 

分 类 号：R641[医药卫生—外科学]