CUSA联合双极电凝在老年肝肿瘤切除术中的应用

朱柯磊　李定耀　陈明良

[摘要] 目的 探讨超声吸引刀（cut-ultrasound aspiration，CUSA）联合双极电凝（bipolar coagulation）在老年肝肿瘤切除术中的临床应用效果。 方法 回顾性分析我院2012年1月～2015年12月56例接受手术治疗的老年肝腫瘤患者的临床资料；根据术中断肝器械的不同随机分为两组：超声吸引刀联合双极电凝（CUSA组）和血管钳钳夹组（钳夹组），比较两组肝门阻断时间、肝门阻断率、断肝时间、手术时间、术中出血量、输血率、术后肝功能情况、术后并发症发生率、术后住院时间的差异，并进行分析评价。 结果 肝门阻断时间、肝门阻断率、术中出血量、输血率、术后肝酶峰值、术后并发症发生率、术后住院时间CUSA组少于钳夹组，有显著性差异（P<0.05）；断肝时间CUSA组多于钳夹组，有显著性差异（P<0.05）；总手术时间两组无显著性差异（P>0.05）。 结论 CUSA联合双极电凝的断肝方式在老年肝肿瘤切除术中具有更好的安全性和更高的经济效益。

[关键词] 超声吸引刀；双极电凝；老年；肝肿瘤

[中图分类号] R657.3 [文献标识码] B [文章编号] 1673-9701（2017）18-0046-04

[Abstract]Objective To analyze the effect of application of cut-ultrasound aspiration combined with bipolar electric coagulation in the excision of geriatric hepatic tumor. Methods The clinical data of 56 cases of geriatric patients with hepatic tumor in our hospital from January 2012 to December 2015 were retrospectively analyzed. These patients were divided into two groups randomly according to different liver cutting instrument. One group was used CUSA combined with bipolar electric coagulation （CUSA group）. The other group was used vascular clamp（clamp group）. The portal vein blocking time， the portal vein blocking rate，hepatectomy time， operation time， intraoperative blood loss，blood transfusion rate，postoperative liver function and postoperative complications， postoperative hospitalization duration were compared between the two groups. Results The portal vein blocking time，the portal vein blocking rate， intraoperative blood loss， blood transfusion rate， the highest value of postoperative alanine aminotransferase， postoperative complications， postoperative hospitalization duration of the CUSA group were significantly lower than those of the clamp group （P<0.05）.Hepatectomy time of the CUSA group were significantly more than those of the clamp group（P<0.05）. There were no differences in the operation time between the two groups（P>0.05）. Conclusion The application of cut-ultrasound aspiration combined with bipolar electric coagulation in hepatectomy was more safty and ecomomical for geriatric patients.

[Key words] Cut-ultrasound aspiration； Bipolar electric coagulation； Geriatric； Hepatic tumor

在我国，肝癌是最常见的恶性肿瘤之一，每年导致约36万人发病，35万人死亡，现已成为所有肿瘤年病死率第二位的疾病[1-3]，随着我国人口老龄化及人均预期寿命增加，老年肝癌的患者逐渐增多，文献报道占同期肝癌患者16.0%～22.5%[4]，我院自2012年1月～2015年12月共收治肝恶性肿瘤患者450例，其中老年人70例，手术治疗56例，现报道如下。

1资料与方法

1.1 一般资料

我院自2012年1月～2015年12月手术治疗老年人肝恶性肿瘤患者56例，其中男42例，女14例；年龄60～79岁，平均（68.0±4.3）岁。肿瘤直径2～12 cm，平均（4±1.5）cm，病灶个数1～3个。肿瘤位于左肝外叶25例，左肝内叶8例，左肝5例，右肝2例，右肝前叶10例，右肝后叶6例，合并分支门脉癌栓2例。……