临床研究(Clinical Research)

剪凝法肝切除初步经验

Published at: 2017年第26卷第1期

肖亮 1 , 周乐杜 1 , 王志明 1
1 中南大学湘雅医院 普通外科,湖南 长沙 410008
通讯作者 乐杜 周 Email: csuzld@126.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2017.01.012
基金:
国家自然科学基金青年基金资助项目 81300342

摘要

目的:介绍一种新的肝实质离断方法——剪凝法。方法:回顾2015年6月―2016年2月中南大学湘雅医院普通外科行肝切除术的30例肝肿瘤患者的临床资料,患者术中均采用剪凝法即单纯使用组织剪和双极电凝断肝。分析围手术期数据,总结剪凝法的技术特点。结果:该30例中24例为肝癌肝硬化患者;行1个肝段切除10例,2个肝段切除12例,半肝切除8例。平均断肝时间19.8(12~38)min,手术时间129.3(80~180)min,术中失血量207.5(60~600)mL,住院时间7.1(5~14)d;所有患者均未输血。术后4例(13.3%)患者发生6次并发症(4例次胸腹水,1例次肺炎,1例次胆汁漏),通过保守治疗均治愈。术后1个月无再出血或死亡病例。结论:剪凝法肝切除安全、有效,可作为一种肝实质离断替代方法在临床使用。


Preliminary experience of using snip-electrocoagulation technique in liver resection

Abstract

Objective: To introduce a novel method for liver parenchymal transaction, i.e., the snip-electrocoagulation technique. Methods: The clinical data of 30 consecutive patients undergoing liver resection for liver tumor in the Department of General Surgery of Xiangya Hospital, Central South University from June 2015 to February 2016 were reviewed. All patients received snip-electrocoagulation technique, namely using dissecting scissors and bipolar coagulation scalpel only, for parenchymal transection during operation. The perioperative data and the technical essentials of this method were analyzed. Results: Of the 30 patients, there were 24 cases of hepatocellular carcinoma with cirrhosis; the procedures included one segment resection in 10 cases, two segments resection in 12 cases and hemihepatectomy in 8 cases. The mean transection time, operative time, total blood loss and length of hospital stay was 19.8 (12–38) min, 129.3 (80–180) min, 207.5 (60–600) mL and 7.1 (5–14) d, respectively, and none of the patients required blood transfusion. Among 4 patients (13.3%), a total of 6 postoperative complications occurred, including pleural effusion and ascites in 4 cases, and pneumonia and bile leak in one case each, but all of them were managed successfully by conservative treatment. There was no rebleeding or death within postoperative one month. Conclusion: Snip-electrocoagulation technique is safe and effective for parenchymal transection, and it is recommended as an alternative method for parenchymal transection to be used in clinical practice.


comments powered by Disqus

全文

引用

引用本文: 亮 肖, 乐杜 周, 志明 王. 剪凝法肝切除初步经验 [J]. 中国普通外科杂志, 2017, 26(1): 70-76.
Cite this article as: XIAO Liang, ZHOU Ledu, WANG Zhiming . Preliminary experience of using snip-electrocoagulation technique in liver resection [J]. Chin J Gen Surg, 2017, 26(1): 70-76.