一次性直线型切割吻合器在右半肝切除中的应用

摘要

Objective To investigate the effect of using articulating endoscopic linear cutter device in right hepatectomy.Methods Analysis of April 2015 to April 2017 treated 36 cases of liver surgery need for right hepatectomy patients,the use of articulating endoscopic linear cutter was performed in 18 cases (Johnson EC60),18 cases of patients with conventional clamp resection of right liver.The observation of broken liver bleeding hepatic resection time postoperative liver function postoperative complications mortality and average hospitalization days.Results The patients were successfully completed right hepatectomy,articulating endoscopic linear cutter group (group A) off liver bleeding was 226.4 ± 47.8 ml,hepatic resection time (Pringle) 19.4 ± 5.6 min hepatic resection time (anatomical block) 52.4 ± 10.4 min,clamping off liver hemorrhage group 272.1 ± 56.8 ml,hepatic resection time (PringIe) 22.4±6.5 min hepatic resection time (anatomical block) 59.3 ± 11.5 min,there was significant difference between two groups (P ＜ 0.05).Three days after operation in A group after 3 days of Alt (U/L) 179.4 ± 65.4,3 days after operation Alb (g/l) 33.5 ± 2.6,3 days after operation TB (μmol/1) 24.7 ± 14.6,B group after 3 days of Alt (U/L) 211.7 ± 78.6,3 days after operation (g/ l Alb 30.1 ± 1.8),after 3 days of TB (μmol/1) 27.3 ± 15.3,there are significant differences between the two groups (P ＜0.05).The postoperative complications average hospitalization mortality were no significant differences in red blood cell transfusion volume (P ＞ 0.05).Conclusions The use of articulating endoscopic linear cutter in the right hepatectomy can reduce the time of liver failure and the amount of bleeding from the liver,and reduce the liver damage caused by the operation.This method is safe and effective.%目的 探讨在右半肝切除中使用一次性直线型切割吻合器的治疗效果.方法 分析2015年4月至2017年4月肝脏外科收治的36例需要行右半肝切除的患者,其中18例术中使用一次性直线型切割吻合器(强生公司EC60),18例患者使用常规钳夹法切除右半肝脏.观察断肝出血量、肝切除时间、术后肝功能、术后并发症、死亡率和平均住院日.结果 患者均顺利完成右半肝切除,直线型切割吻合器组(A组)断肝出血量226.4±47.8 ml,肝切除时间(Pringle法)19.4±5.6 min肝切除时间(解剖性阻断)52.4±10.4 min,钳夹法组断肝出血量272.1±56.8ml,肝切除时间(Pringle法)22.4±6.5 min肝切除时间(解剖性阻断)59.3±11.5 min,二组间均有明显差异(P＜0.05).术后三天A组术后3天Ah(U/L) 179.4±65.4,术后3天Alb(g/l)33.5 ±2.6,术后3天TB(μmol/1)24.7±14.6,B组术后3天Ah(U/L)211.7±78.6,术后3天Alb (g/l) 30.1±1.8,术后3天TB(μmol/1)27.3±15.3,二组间有明显差异(P＜0.05).术后并发症、平均住院日、死亡率、输红细胞量均无明显差异(P＞0.05).结论 在右半肝切除中使用一次性血管闭合器能减少断肝时间、断肝出血量,减轻手术造成的肝功能损害.这种方法是安全有效的.