射频凝固器在肝癌肝切除术中的应用  

Application of radiofrequency ablation in liver resection for hepatic cancer

作　　者：夏锋[1] 马宽生[1] 李晓武[1] 王曙光[1] 别平[1] 

机构地区：[1]第三军医大学西南医院全军肝胆外科研究所、中国人民解放军西南肝胆外科医院,重庆400038

出　　处：《中华消化外科杂志》2012年第6期507-510,共4页Chinese Journal of Digestive Surgery

摘　　要：目的探讨射频凝固器与传统钳夹法行肝癌肝切除术对术中出血和术后并发症的影响。方法回顾性分析2011年1月至2012年6月第三军医大学西南医院收治的130例肝癌患者的临床资料，采用配对病例对照研究方法，将65例采用射频凝固器进行肝切除术的肝癌患者设立为射频凝固器组；同时根据肿瘤的大小、部位和Child—Pugh分级在肝癌数据库中配对选取65例临床病理特征类似的采用传统钳夹法进行肝切除术的患者设立为传统钳夹组。对两组患者术中和术后的相关参数进行统计学对比分析。计量资料用中位数加范围表示，均数比较用方差分析；计数资料比较用）f2检验，当例数〈10时采用Fisher确切概率法。结果射频凝固器组患者的术中断肝时间和肝门阻断时间分别为28min（12—55min）和10rain（0～15min），明显短于传统钳夹组的45min（25～92min）和15min（10—32rain），两组比较，差异有统计学意义（F=10．35，9．05，P〈0．05）；射频凝固器组患者的术中出血量和术中输血量分别为150ml（50～350m1）和0rrd，显著少于传统钳夹组的450m1（250～2500m1）和550ml（0—2000m1），两组比较，差异有统计学意义（F=15．86，P〈0．05）；射频凝固器组65例患者未输血，显著多于传统钳夹组的48例（x^2=19．58，P〈0．05）。射频凝固器组患者术后第3、7天AST和TBil，术后第3天PT、Clavien外科并发症分级、住院时间分别为302U／L（89—823U／L）、54u／L（16～325U／L）、37μmol／L（18～112μmol／L）、24μmo]／L（9—66μmol／L）、15S（11—20S）、22％（14／65）、12d（8～36d），与传统钳夹组的253U／L（63—876U／L）、62U／L（22—376U／L）、41μmol／L（19～105μmol／L）、25μmol／L（11～59μmol／L）、14s（11～21s）、26％（17／65）、13d（9～35d）比较，差异无统计学意义（F=2．59，1．93，3．96，1．58，2．35，√=0Objective To compare the effects of radiofrequency ablation and clamp crushing resection on intraoperative blood loss and postoperative complications. Methods The clinical data of 130 patients with hepatic cancer who were admitted to the Southwest Hospital from January 2011 to June 2012 were retrospectively analyzed. Sixty-five patients who received radiofrequency ablation were in the radiofrequency ablation group; the clinical data of 65 hepatic cancer patients with similar tumor size, position and Child-Pugh scores who received traditional clamp crushing resection were selected from the data base, and they were in the clamp crushing resection group. The intra- and postoperative clinical data of the 2 groups were statistically analyzed. The measurement data were presented in the format of median plus range, and were analyzed using the analysis of variance; the enumeration data were analyzed using chi-square test, when the number of patients was under 10, the Fisher exact probability was used for analysis. Results Tile time for liver resection and hepatic inflow occlusion in the radiofrequency ablation group were 28 minutes （range, 12-55 minutes） and 10 minutes （range, 0-15 minutes）, which were significantly shorter than 45 minutes （range, 25-92 minutes） and 15 minutes （range, 10-32 minutes） in the clamp crushing resection group （F= 10. 35, 9. 05, P〈0.05）. The volumes of intraoperative blood loss and blood transfusion were 150 ml （range, 50-350 ml） and 0 ml in the radiofrequency ablation group, which were significantly lesser than 450 ml （ range, 250-2500 ml） and 550 ml （ range, 0-2000 ml） in the clamp crushing resection group （F = 15.86, P 〈 0.05 ）. The number of patients who did not receive blood transfusion in the radiofrequency ablation group was 65, which was significantly greater than 48 in the clamp crushing resection group （X2 = 19.58, P 〈 0.05 ）. The levels of aspartic transaminase （AST） and total bilirubin （TBil） at postoperative day 3 and 7, prothro

关 键 词：肝肿瘤 肝切除术 钳夹法 射频消融 

分 类 号：R735.7[医药卫生—肿瘤]