Lupo L, Gallerani A, Panzera P, Tandoi F, Di Palma G, Memeo V
Department of Emergency and Organ Transplantation, Institute of General Surgery and Liver Transplantation, University of Bari, piazza Giulio Cesare 12, 70124 Bari, Italy.
Br J Surg. 2007 Mar;94(3):287-91. doi: 10.1002/bjs.5674.
Surgical resection remains the treatment of choice for primary and secondary liver cancer. Complications are mainly related to blood loss. Radiofrequency-assisted liver resection (RF-R) has been proposed for parenchymal division as an alternative to clamp crushing in order to reduce blood loss.
Fifty patients (median age 62 (range 30-82) years) undergoing hepatectomy were randomized to RF-R (24 patients) or the clamp-crushing method (26). In the RF-R group the resection plane was precoagulated by multiple insertion of a planar triple-cooled radiofrequency ablation needle, and then the parenchyma was sectioned using a scalpel.
The two groups were well matched in terms of age, sex, liver disease and type of resection. There were no deaths. Eight in the RF-R group developed complications (abscess in six, biliary fistula in three and biliary stenosis in one) compared with none of those who had resection by the crush method (P < 0.001). Two patients with cirrhosis in each group developed decompensation. Blood transfusion was required in eight of 24 patients in the RF-R group and 13 of 26 in the clamp-crushing group (P = 0.079).
RF-R allows parenchymal resection in a clean surgical field but is associated with a higher rate of postoperative complications than the clamp-crushing technique.
手术切除仍然是原发性和继发性肝癌的首选治疗方法。并发症主要与失血有关。为了减少失血，已提出采用射频辅助肝切除术（RF-R）进行实质分割，作为钳夹破碎法的替代方法。
50例行肝切除术的患者（中位年龄62岁（范围30 - 82岁））被随机分为RF-R组（24例）和钳夹破碎法组（26例）。在RF-R组中，通过多次插入平面三冷射频消融针预凝切除平面，然后用手术刀切开实质。
两组在年龄、性别、肝脏疾病和切除类型方面匹配良好。无死亡病例。RF-R组有8例发生并发症（6例脓肿、3例胆瘘和1例胆管狭窄），而采用钳夹破碎法切除的患者无一例发生并发症（P < 0.001）。每组各有2例肝硬化患者发生失代偿。RF-R组24例中有8例需要输血，钳夹破碎组26例中有13例需要输血（P = 0.079）。
RF-R可在清洁的手术视野中进行实质切除，但与钳夹破碎技术相比，术后并发症发生率更高。
