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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

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x2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28 min(12~55 min)和10 min(0~ 15 min),明显短于传统钳夹组的45min(25 ~92m in)和15 min(10~32min),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 ~350ml)和0ml,显著少于传统钳夹组的450 ml (250~ 2500 ml)和550 ml(0~2000 ml),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(x2=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302 U/L(89 ~823 U/L)、54 U/L(16 ~325 U/L)、37 μmol/L(18~112 μmol/L)、24 μmol/L(9~66 μmol/L)、15 s(11 ~20 s)、22%(14/65)、12 d(8 ~36 d),与传统钳夹组的253 U/L(63~876 U/L)、62 U/L(22 ~ 376 U/L)、41 μmol/L(19 ~ 105 μmol/L)、25tμmol/L(11 ~59 μmol/L)、14 s(11 ~21 s)、26% (17/65)、13 d(9 ~35 d)比较,差异无统计学意义(F =2.59,1.93,3.96,1.58,2.35,x2=0.381,F=1.58,P>0.05);射频凝固器并发症发生率为17%(11/65),显著低于传统钳夹组的52%(34/65),两组比较,差异有统计学意义(x2=17.38,P<0.05).其中射频凝固组只有2例患者发生术后出血,显著少于传统钳夹组的22例.但射频凝固器组有8例患者发生断面包裹性积液,其中5例需穿刺引流.传统钳夹组有2例患者发生肝功能不全;射频凝固器组有2例患者发生血红蛋白尿.结论 与传统钳夹法比较,射频凝固器行肝切除术具有出血少、安全、快捷的优点.

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abstracts:

Objective 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 The 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,prothrombin time (PT) at postoperative day 3,Clavien classification of surgical complications,duration of hospital stay were 302 U/L (range,89-823 U/L),54 U/L (range,16-325 U/L),37 μmol/L(range,18-112 μmol/L),24 μmol/L (range,9-66 μmol/L),15 s (range,11-20 s),22% (14/65),12 days (range,8-36 days) in the radiofrequency ablation group,and 253 U/L (range,63-876 U/L),62 U/L(range,22-376 U/L),41 μmol/L (range,19-105 μmol/L),25 μmol/L (range,11-59 μmol/L),14 s (range,11-21 s),26% (17/65) and 13 days (range,9-35 days) in the clamp crushing resection group.There were no significant differences in the 7 indexes between the radiofrequency ablation group and the clamp crushing resection group (F=2.59,1.93,3.96,1.58,2.35,x2 =0.381,F=1.58,P>0.05).The incidence of complications of the radiofrequency ablation group was 17% (11/65),which was significantly lower than 52% (34/65) of the clamp crushing resection group (x2 =17.38,P < 0.05).The number of patients who had postoperative bleeding in the radiofrequency ablation group was 2,which was significantly lesser than 22 patients in the clamp crushing resection group.Eight patients in the radiofrequency ablation group had encapsulated effusion,and 5 of them need drainage.Two patients in the clamp crushing resection group had hepatic insufficiency.Two patients in the radiofrequency ablation group had hemoglobinuria.Conclusion Compared with clamp crushing resection,radiofrequency ablation has advantages of less blood loss and safer manipulation.

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