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目的 :探讨微波刀在不阻断入肝血流对合并肝硬化肝癌切除术中的临床应用价值。方法:将2012年2月—2014年2月收治的80例合并肝硬化的肝癌患者分成实验组和对照组。实验组手术方式为微波凝固切肝法,对照组为普通钳夹法。分别观察两组患者围手术期情况和1年随访结果,包括肝切除时间、肝切除面积、肝切除速度、失血量、结扎数量、有无输入红细胞、发生出血需行肝门阻断例数,以及术后3 d和7 d的谷丙转氨酶、总胆红素、血白蛋白、术后并发症、死亡率和术后住院时间。结果:术中微波凝固切肝法组在肝切除失血量及结扎(包括钛夹、缝扎等)数量与传统钳夹组相比差异均有统计学意义(P<0.05)。微波凝固切肝法组术中发生出血需行肝门阻断的例数与传统钳夹法组相比差异均有统计学意义(P<0.05)。术后第3天,微波凝固切肝法组患者血清白蛋白水平显著高于钳夹法组,血清丙氨酸氨基转移酶、总胆红素水平明显低于钳夹法组,差异均有统计学意义(P<0.05)。其余指标差异无统计学意义(P>0.05)。结论:在合理掌握指征情况下,不阻断入肝血流微波凝固切肝法对肝脏损伤更小,术中出血更少,患者术后恢复更快。
Objective: To investigate the clinical value of microwave knife in the treatment of hepatocellular carcinoma with cirrhosis without blocking the blood flow in the liver. Methods: Eighty patients with liver cirrhosis who were admitted from February 2012 to February 2014 were divided into experimental group and control group. The experimental group was operated by microwave coagulation and hepatectomy, while the control group was treated by conventional clamp method. Perioperative conditions and 1-year follow-up results of two groups were observed, including the time of hepatectomy, the area of hepatectomy, the rate of hepatectomy, the amount of blood loss, the number of ligation, the number of red blood cells, And alanine aminotransferase, total bilirubin, albumin, postoperative complications, mortality and postoperative hospital stay on postoperative 3 and 7 days. Results: The amount of blood loss and the number of ligation (including titanium clip, suture, etc.) in the group of microwave coagulation and hepatectomy during operation were significantly different from those of the traditional clamp group (P <0.05). There were significant differences in the number of cases requiring hepatic portal vein occlusion between the two groups (P <0.05). On the third day after operation, serum albumin level in patients undergoing microwave coagulation and hepatectomy was significantly higher than that in the clamp group, serum alanine aminotransferase and total bilirubin levels were significantly lower than those of the clamp group, with statistical differences Significance (P <0.05). The remaining indicators showed no significant difference (P> 0.05). Conclusion: Under the condition of reasonable indications, microwave coagulation and hepatic resection without occluding hepatic blood flow can lessen liver damage and reduce intraoperative bleeding. Patients recover faster after operation.