射频消融切肝技术在胆囊癌根治术中的临床应用

目的探讨射频消融切肝技术在胆囊癌根治术中应用的安全性和临床疗效。方法对2010年1月～2012年1月收治的18例胆囊癌患者在根治术中应用射频消融切肝技术,并对手术安全性及临床疗效评价。结果 18例胆囊癌按TNM分期,Ⅱ期12例,Ⅲ期6例。应用射频消融切肝技术,行胆囊癌根治术14例:均行切除胆囊床的2cm肝脏部分Ⅳb段+Ⅴ段肝切除;扩大根治术4例:行Ⅳb段+右半肝切除1例,Ⅴ段+左半肝+肝外胆管切除1例,行Ⅴ段+左半肝+尾状叶+肝外胆管切除2例。平均切除时间为(65±30)min,出血量为(217±105)ml。所有患者术中生命体征平稳,术后发生胆汁漏4例、胸腔积液2例,均经积极非手术治疗痊愈。18例患者无术后腹腔内出血、肝功能衰竭、伤口感染和围手术期死亡。术后平均住院时间为(24±11)d。结论射频消融切肝技术在胆囊癌根治术中的应用具有安全、出血少、疗效好等优点,值得临床推广应用。

Clinical application research of radiofrequency-assisted hepatectomy in gallbladder carcinoma radical resection

Objective To investigate the clinical efficacy and safety of radiofrequency-assisted hepatectomy in the gallbladder carcinoma radical resection.Methods We treated 18 patients by radiofrequency-assisted hepatectomy in the gallbladder carcinoma radical resection.Clinical data were retrospectively analyzed.Results Accordant to TNM criterion,these cases were recognized as 12 cases with T2,6 cases with T3.Fourteen patients received the gallbladder carcinoma radical resection,including SⅣb+SⅤ at 2cm distances from cystic bed wedge hepatectomy.Four patients received the gallbladder carcinoma extended radical resection,include SIVb + right hepatectomy in one patient,SⅤ+left hepatectomy and extrahepatic bile duct resection in one patient,SⅤ+left+Spiegel hepatectomy and extrahepatic bile duct resect in two patients.The mean operation time was(65±30) minutes and the mean blood loss was(217±105) ml.Four patient was complicated with bile leakage,two with pleural effusion,and they were cured by non-surgical treatment.There were no patients with postoperative hemorrhage,incision infection or hepatic failure.No mortality was observed.The mean postoperative hospital stay was(24±11) days.Conclusion Radiofrequency-assisted hepatectomy in the gallbladder carcinoma radical resection appears to be efficacious and safe for disintegrating and removing renal calculi.