射频止血系统在肝切除术中的应用(附65例报告)

摘要

Objective We aimed to introduce a new method of liver resection using radiofrequency hemostatic system and evaluate the clinical safety and efficacy.Methods From June 2015 to June 2016,11 patients underwent anatomical hepatectomy using radiofrequency hemostatic system.Fifty-four patients were subjected to hepatectomy using radiofrequency hemostatic system in combination with other equipments (harmonic scalpel,BiClamp and CUSA).Results In patients using radiofrequency hemostatic system only,9 of 11 cases underwent hepatectomy without blood inflow occlusion.Hemihepatic blood flow occlusion was performed on 1 patient who was given left hemihepatectomy.Chen's occlusion method (Pringle maneuver combined within frahepatic inferior vena cava clamping) was performed on 1 patient.The median volume of intraoperative bleeding was 150 mL (30-300 mL),and the median of operative time was 200 min (90-250 min).For patients using radiofrequency hemostatic system plus other equipment,33 cases received hepatectomy without any blood inflow occlusion,3 cases Chen`s occlusion method and 5 cases Pringle maneuver.In 10 cases receiving hemihepatectomy and 3 cases extended hemiheatectomy,the corresponding inflow vessels were pre-ligated.One case of donor hepatectomy was not given any blood control technique.All cases recovered in two weeks without perioperative mortality and serious complication.The median of intraoperative blood loss was 230 mL (50-500 mL),and the median of operative time was 240 min (90-360 min).Conclusions The new method of liver resection using radiofrequency hemostatic system could minimize intraoperative bleeding,and avoid the ischemia-reperfusion injury caused by hepatic blood flow occlusion.This approach has bright prospects for clinical application in hepatic surgery.%目的 介绍一种新的射频止血系统在肝切除术中的应用情况并评估其安全性及有效性.方法 2015年6月至2016年6月间11例病人单独使用射频止血系统行肝切除术,54例病例采用射频止血系统与其他肝切除设备[超声刀、双极电凝钳和超声吸引刀(cavitron ultrasonic surgical aspirator,CUSA)]配合使用行肝切除术.使用射频止血系统解剖第一肝门、离断肝周韧带,使用其他切肝设备离断肝脏实质,肝断面出血点采用射频止血系统止血.结果 11例单独使用射频止血切肝的病人中,有9例没有行肝脏血流阻断,1例左半肝切除病人预先结扎患侧入肝血流,1例左半肝切除术中行陈氏肝血流阻断(第一肝门阻断联合肝下下腔静脉阻断);中位出血量为150 ml(30~300 ml),中位手术时间为200 min(90~250 min).射频止血系统配合使用其他切肝设备54例病例中:腹腔镜肝切除术33例,开腹手术21例;33例未采用任何血流阻断方法(59.3%),第一肝门联合下腔静脉阻断3例,第一肝门阻断5例,10例半肝切除及3例扩大左半肝切除均预先处理患侧血管;54例中有1例活体肝移植供肝手术未采用任何血流阻断技术;腹腔镜手术无中转开腹;中位出血量为230 ml(50~500 ml),中位手术时间为240 min(90~360 min).所有病例均未输血,均恢复顺利,无严重术后并发症,无围手术期死亡.结论 在肝切除术中使用射频止血系统可减少术中出血量,避免肝血流阻断带来的缺血再灌注损伤,操作简单,值得推广.