陈泽斌; 胡文杰; 周倩; 沈顺利; 黎东明; 梁力建; 匡铭

doi:10.3877/cma.j.issn.2095-3232.2019.01.011

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• 临床研究 •

微波固化辅助腹腔镜肝细胞癌肝切除减少术中出血

中华肝脏外科手术学电子杂志, 2019,08(1) : 45-49. DOI: 10.3877/cma.j.issn.2095-3232.2019.01.011

摘要

目的

探讨微波固化技术减少腹腔镜肝细胞癌（肝癌）肝切除术中出血的有效性及可行性。

方法

回顾性分析2013年6月至2017年6月在中山大学附属第一医院接受腹腔镜肝癌肝切除的35例患者临床资料。患者均签署知情同意书，符合医学伦理学规定。根据术中是否应用微波固化，将患者分为微波固化辅助腹腔镜肝癌切除组（微波组）和单纯行腹腔镜肝癌切除组（腔镜组）。其中微波组12例，男8例，女4例；平均年龄（57±7）岁。腔镜组23例，男18例，女5例；年龄（51±12）岁。两组患者围手术期出血量比较采用Wilcoxon秩和检验，率的比较采用χ²检验或Fisher确切概率法。生存分析采用Kaplan-Meier法和Log-rank检验。

结果

微波组术中出血量90（50，200）ml，明显少于腔镜组的200（100，500）ml（Z=-2.520，P<0.05）。两组术后并发症发生率分别为8.3%、8.7%，差异无统计学意义（P=1.000）。微波组和腔镜组2年无瘤生存率分别为66.7%、69.6%，2年总体生存率分别为70.1%、87.7%，差异均无统计学意义（χ²=0.075，0.082；P>0.05）。

结论

微波固化能有效减少腹腔镜肝癌肝切除术中出血，提高手术安全性，是一种有效的辅助切肝手段。

引用本文: 陈泽斌, 胡文杰, 周倩, 等. 微波固化辅助腹腔镜肝细胞癌肝切除减少术中出血 [J/OL] . 中华肝脏外科手术学电子杂志, 2019, 08(1) : 45-49. DOI: 10.3877/cma.j.issn.2095-3232.2019.01.011.

参考文献导出: Endnote NoteExpress RefWorks NoteFirst 医学文献王

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肝细胞癌（肝癌）是我国最常见的恶性肿瘤之一，病死率居全球肿瘤相关死亡第3位，每年超过70万人死于肝癌^[1] 。手术为最有可能治愈肝癌的手段。随着微创技术的不断发展，腹腔镜肝切除在肝癌治疗中应用逐渐普遍，但术中出血是腹腔镜肝切除不可忽视的问题，特别是对于合并肝硬化的肝癌患者，出血风险更高。减少出血能降低手术对肝功能的影响，缩短患者恢复时间^[2]。微波固化是肝癌局部治疗手段之一，采用局部高温灭活肿瘤细胞，同时研究发现，微波固化有良好的肝脏止血功能^[3,4]。目前，关于微波固化技术在辅助腹腔镜肝癌切除术中应用的报道较少，理论上联合微波固化辅助肝切除可减少腹腔镜肝癌切除术中出血，因此本文通过临床病例对照研究，探讨微波固化技术对减少腹腔镜肝癌切除术中出血的安全性和有效性。

贡献者信息

陈泽斌

510080　广州，中山大学附属第一医院肝脏外科

胡文杰

510080　广州，中山大学附属第一医院肝脏外科

周倩

510080　广州，中山大学附属第一医院临床研究中心

沈顺利

510080　广州，中山大学附属第一医院肝脏外科

黎东明

510080　广州，中山大学附属第一医院肝脏外科

梁力建

510080　广州，中山大学附属第一医院肝脏外科

匡铭

510080　广州，中山大学附属第一医院肝脏外科

通信作者

匡铭

510080　广州，中山大学附属第一医院肝脏外科

Email：kuangm@mail.sysu.edu.cn

关键词

癌，肝细胞; 肝切除术; 微波; 腹腔镜;

作者声明

陈泽斌，胡文杰，周倩，等．微波固化辅助腹腔镜肝细胞癌肝切除减少术中出血[J/CD]．中华肝脏外科手术学电子杂志，2019，8(1)：45-49.

历史

出版日期：2019-02-10

收稿日期：2018-10-18

本文编辑

曾宇虹杨扬

Clinical Researches

Effect of microwave coagulation on reducing intraoperative bleeding during laparoscopic hepatectomy for hepatocellular carcinoma

Zebin Chen, Wenjie Hu, Qian Zhou, Shunli Shen, Dongming Li, Lijian Liang, Ming Kuang

Published 2019-02-10

Cite as Chin J Hepat Surg(Electronic Edition), 2019, 08(1): 45-49. DOI: 10.3877/cma.j.issn.2095-3232.2019.01.011

Abstract

Objective

To investigate the efficacy and feasibility of microwave coagulation in reducing the intraoperative bleeding during laparoscopic hepatectomy for hepatocellular carcinoma (HCC).

Methods

Clinical data of 35 patients undergoing laparoscopic hepatectomy for HCC in the First Affiliated Hospital of Sun Yat-sen University from June 2013 to June 2017 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. According to whether the microwave coagulation was used during the operation, the patients were divided into microwave coagulation-assisted laparoscopic liver resection group (microwave group) and laparoscopic liver resection group (laparoscopic group). In the microwave group (n=12), 8 patients were male and 4 were female, aged (57±7) years on average. In the laparoscopic group (n=23), 18 cases were male and 5 were female, aged (51±12) years on average. The perioperative blood loss between two groups was statistically compared by Wilcoxon rank-sum test. The ratio comparison was performed by Chi-square test or Fisher's exact probability test. Survival analysis was performed by Kaplan-Meier survival curve and Log-rank test.

Results

The intraoperative blood loss in microwave group was 90(50, 200) ml, significantly less than 200(100, 500) ml in laparoscopic group (Z=-2.520, P<0.05). The incidence of postoperative complications was respectively 8.3% and 8.7% in microwave and laparoscopic group, where no significant difference was observed (P=1.000). The 2-year tumor-free survival rate was respectively 66.7% and 69.6% in microwave and laparoscopic group, and the 2-year overall survival rate was respectively 70.1% and 87.7%, where no significant difference was observed (χ²=0.075, 0.082; P>0.05).

Conclusions

Microwave coagulation can effectively reduce the intraoperative bleeding during laparoscopic hepatectomy for HCC and improve the safety of operation, which is an effective assisting technique for liver resection.

Key words:

Carcinoma, hepatocellular; Hepatectomy; Microwaves; Laparoscopes

Contributor Information

Zebin Chen