新型内部冷循环双极射频装置在开腹肝切除术中的应用价值

Application value of a new internal cold circulation bipolar radio frequency device in open hepatectomy

    摘要
  • 摘要:
    目的 探讨新型内部冷循环双极射频装置在开腹肝切除术中的应用价值。
    方法 采用回顾性队列研究方法。收集2017年2月至2020年1月郑州大学附属肿瘤医院收治的85例肝细胞癌行开腹肝切除术病人的临床资料；男48例,女37例；中位年龄为52岁,年龄范围为32~74岁。85例病人中,45例使用新型内部冷循环双极射频装置辅助行肝切除术,设为新型内部冷循环双极射频装置组,40例使用Habib‑4X双极射频装置辅助行肝切除术,设为Habib‑4X组。观察指标：（1）术中情况。（2）术后情况。（3）随访情况。采用门诊、住院复查和电话方式进行随访。了解病人术后并发症和30 d内死亡情况。随访时间截至2020年5月。正态分布的计量资料以x±s表示,组间比较采用独立样本t检验。偏态分布的计量资料以M（范围）表示,组间比较采用非参数Mann‑Whitney U检验。计数资料以绝对数表示,组间比较采用χ²检验或Fisher确切概率法。重复测量资料采用重复测量方差分析。
    结果 （1）术中情况：新型内冷循环双极射频装置组肝实质横切过程手术时间、平均面积横切速度、凝固组织宽度、针道出血、电极针头炭化分别为（55±16）min、（4.8±1.2）cm2/min、（1.4±0.2）cm、6例、10例,Habib‑4X组上述指标分别为（64±15）min、（3.6±1.0）cm2/min、（1.8±0.2）cm、14例、25例,两组病人上述指标比较,差异均有统计学意义（t=2.665、4.973、9.204,χ²=5.525、14.184,P<0.05）。（2）术后情况：新型内部冷循环双极射频装置组病人术后第1、3、7天总胆红素（TBil）分别为（20±12）μmol/L、（25±12）μmol/L、（20±14）μmol/L,凝血酶原时间（PT）分别为（15.4±2.2）s、（14.2±2.1）s、（12.7±0.8）s,丙氨酸氨基转移酶（ALT）分别为（288±248）IU/L、（132±61）IU/L、（67±32）IU/L,天冬氨酸氨基转移酶（AST）分别为（279±114）IU/L、（50±22）IU/L、（30±13）IU/L；Habib‑4X组上述指标分别为（22±15）μmol/L、（23±10）μmol/L、（19±8）μmol/L,（15.8±2.8）s、（14.3±2.0）s、（13.6±1.3）s,（369±269）IU/L、（133±99）IU/L、（54±30）IU/L,（345±125）IU/L、（60±36）IU/L、（32±11）IU/L,两组PT、ALT、AST的时间效应比较,差异均有统计学意义（F=18.364,23.020,93.786,P<0.05）。TBil的时间效应、组间效应、交互效应,PT、ALT、AST的组间效应和交互效应比较,差异均无统计学意义（F=2.421、1.424、0.522,1.593、0.312,0.121、0.267,1.027、0.600,P>0.05）。（3）随访情况：85例病人均获得随访,随访时间为4~39个月,中位随访时间为16个月。新型内部冷循环双极射频装置组5例病人发生并发症,Habib‑4X组8例发生并发症,两组病人总体并发症比较,差异无统计学意义（χ²=1.292,P>0.05）。新型内部冷循环双极射频装置组和Habib‑4X组死亡例数分别为0和1例,两组比较差异无统计学意义（P>0.05）。
    结论 新型内部冷循环双极射频装置应用于开腹肝切除术安全、有效,肝实质横切速度更快、电极针尖端炭化率更低、凝固范围更加精准。

     

    Abstract:
    Objective To investigate the application value of a new internal cold circula-tion bipolar radio frequency device in open hepatectomy.
    Methods The retrospective cohort study was conducted. The clinical data of 85 patients with hepatocellular carcinoma who underwent open hepatectomy at the Affiliated Tumor Hospital of Zhengzhou University from February 2017 to January 2020 were collected. There were 48 males and 37 females, aged from 32 to 74 years, with a median age of 52 years. Of 85 patients, 45 cases undergoing hepatectomy assisted by the new internal cold circulation bipolar radio frequency device were allocated into new internal cold circulation bipolar radio frequency device group, and 40 cases undergoing hepatectomy assisted by Habib-4X bipolar radio frequency device were allocated into Habib-4X group, respectively. Observation indicators: (1) intraoperative situations; (2) postoperative situations; (3) follow-up. Follow-up was conducted by outpatient, inpatient reexamination and telephone interview to detect the postoperative complications and death of patient within postoperative 30 days up to May 2020. Measurement data with normal distribution were represented as Mean±SD, and independent sample t test was used for comparison between groups. Measurement data with skewed distribution were expressed as M(range), and nonparametric Mann-Whitney U test was used for comparison between groups. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Repeated measurement data were anlyzed by the repeated ANOVA.
    Results (1) Intraoperative situations: the time of crosscutting process for liver parenchyma, average area transection speed, coagulation tissue width, cases with needle bleeding rate and electrode needle charring were (55±16)minutes, (4.8±1.2)cm2/minute, (1.4±0.2)cm, 6, 10 for the new internal cold circulation bipolar radio frequency device group, versus (64±15)minutes, (3.6±1.0)cm2/minute, (1.8±0.2)cm, 14, 25 for the Habib-4X group, respectively, showing significant differences in the above indicators between the two groups (t=2.665, 4.973, 9.204, χ2=5.525, 14.184, P<0.05). (2) Postoperative situations: for the new internal cold circulation bipolar radio frequency device group, the total bilirubin (TBil) was (20±12)μmol/L, (25±12)μmol/L, (20±14)μmol/L at postoperative 1, 3, 7 days, the prothrombin time (PT) was (15.4±2.2)seconds, (14.2±2.1)seconds, (12.7±0.8)seconds, the alanine aminotransferase (ALT) was (288±248)IU/L, (132±61)IU/L, (67±32)IU/L, the aspartate aminotransferase (AST) was (279±114)IU/L, (50±22)IU/L, (30±13)IU/L. For the Habib-4X group, the TBil was 1(22±15)μmol/L, (23±10)μmol/L, (19±8)μmol/L at postoperative 1, 3, 7 days, PT was (15.8±2.8)seconds, (14.3±2.0)seconds, (13.6±1.3)seconds, the ALT was (369±269)IU/L, (133±99)IU/L, (54±30)IU/L, the AST was (345±125)IU/L, (60±36)IU/L, (32±11)IU/L. There were significant differences in the time effect of PT, ALT, AST between the two groups (F=18.364, 23.020, 93.786, P<0.05). There was no significant difference in the time effect, between-group effect, interaction effect of TBil or between-group effect, interaction effect of PT, ALT, AST between the two groups (F=2.421, 1.424, 0.522, 1.593, 0.312, 0.121, 0.267, 1.027, 0.600, P>0.05). (3) Follow-up: 85 patients were followed up for 4 to 39 months, with a median follow-up time of 16 months. There were 5 patients in the new internal cooling circulation bipolar radiofrequency device group and 8 patients in the Habib-4X group with complications, respectively, showing no significant difference in overall complications between the two groups (χ2=1.292, P>0.05). The number of deaths in the new internal cooling circulation bipolar radio frequency device group and Habib-4X group was 0 and 1, respectively, showing no significant difference between the two groups (P>0.05).
    Conclusion The new internal cold-circulating bipolar radio frequency device for open hepatectomy is safe and effective, which cuts the liver parenchyma faster, has lower carbonization rate at the tip of electrode needle, and has more accurate coagulation range.

     

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