肝切除创面三种处理方法的随机对照研究

目的 研究肝创面不同处理方法 ,指导手术治疗.方法 按随机分组原则,将58例肝肿瘤切除术后的肝创面分为A组(肝创面敞开用微孔多聚糖止血球组)、B组(肝创面敞开用氩气刀烧灼组)、C组(肝创面对拢缝合组),记录术中创面的出血量、止血时间、术后引流量及肝功能等指标,比较其间的差异.结果 A、B、C组在年龄、性别、肿瘤大小、肝门阻断方法 、阻断时间、有无门静脉癌栓、术后创面引流量、血常规、白蛋白、前白蛋白、球蛋白、胆红素上无明显差异(P>0.05);C组的止血时间明显短于A、B两组(P<0.05);A组和C组的创面出血量明显低于B组(P<0.05),A、C两组间无显著差异;在术后24 h、3 d、7d丙氨酸转氨酶(ALT)比较上,A组和B组升高显著低于C组,恢复也较快(P<0.05),A组与B组比较无差异.结论 肝肿瘤切除术后肝创面的处理直接影响到肝创面出血量及术后肝功能的恢复,应根据病人的病情选择创面敞开还是对拢缝合.创面敞开时的止血必须彻底,术中应采用合适的止血方法 及止血材料.

A randomized controlled clinical study on 3 methods for management of hepatic cutting surface in hepatectomy

Objective To summarize the experience in managing hepatic cutting surface in hepa-tectomy. Methods Fifty-eight patients receiving hepatectomy were divided into 3 groups according to the condition of the hepatic cutting surface. The hepatic cutting surface was open and managed with application of stypic powder in group A, open and cauterized by argon bistoury in group B and sutured in group C. The hemorrhage volume of wound surface, hemostasis time-consumption in operation and drainage volume, hepatic function after operation were determined and compared among the 3 groups. Results There were no significant differences among the 3 groups in age, sex, tumor size, method of hepatic portal blockage, blockage time, portal vein cancer embolus, wound surface drainage volume after operation, hepatitis immunity, blood routine, prothrombin time, AFP, albumin, pre-albumin, globumin and bilirubin (P>0.05). However, the hemorrhage volume of wound surface was signifi-cantly less in group A and C than in group B (P<0.05). There was no significant difference between group A and C (P>0.05). Meanwhile, the change in GPT was remarkably lower in group A and B than in group C 24 h, 3 d and 7 d after operation (P<0.05). But there was no significant difference between group A and B. Conclusion The management of hepatic cutting surface will directly affect hemorrhage volume and liver function. To avoid hemorrhage, we can apply stypic powder or other he-mostatic or suture hepatic cutting surface. To avoid hepatic failure, we can make the cutting surface open to lessen the damage of remain liver. However, the best method for preventing hemorrhage and hepatic failure is to make the cutting surface open and apply stypic powder or other hemostatics. We should choose the three methods flexibly according to patients" economic and pathological conditions.