Sandonato Luigi, Soresi Maurizio, Cipolla Calogero, Bartolotta Tommaso V, Giannitrapani Lydia, Antonucci Michela, Galia Massimo, Latteri Mario A
Department of Oncology, Division of General and Oncological Surgery, Interdepartmental Unit for Hepatic Neoplastic Disease, University of Palermo, Italy.
Am Surg. 2011 Nov;77(11):1490-5.
Hemorrhage and postoperative liver insufficiency are frequent and serious complications of hepatic resection in cirrhotic patients. The aim of this study was to assess retrospectively whether the surgical techniques using Kelly clamp crushing resection or heat coagulative necrosis with a bipolar radiofrequency device can reduce the incidence of the above complications and an eventual recurrence of neoplasia on the liver slice. We retrospectively reviewed the results of 35 patients who had undergone resection for monofocal hepatocellular carcinoma at our center. Thirteen patients (Group A) had undergone liver resection with Kelly clamp crushing resection, 22 patients (Group B) had had liver resection assisted with a bipolar radiofrequency device. Radiofrequency-assisted liver resection was associated with diminished blood loss (P < 0.0001), a lower blood transfusion rate (P < 0.005), reduced operative time (P < 0.0001), and better postoperative serum albumin levels (P < 0.03). This nonrandomized retrospective study suggests that radiofrequency-assisted liver resection is associated with better results than the Kelly clamp crushing resection technique in cirrhotic patients with focal hepatocellular carcinoma and preserved liver function. These results should now be assessed prospectively in a randomized clinical trial.
出血和术后肝功能不全是肝硬化患者肝切除术后常见且严重的并发症。本研究的目的是回顾性评估使用凯利钳挤压切除或双极射频设备进行热凝坏死的手术技术是否能降低上述并发症的发生率以及肝切片上肿瘤最终复发的情况。我们回顾性分析了在本中心接受单灶性肝细胞癌切除术的35例患者的结果。13例患者（A组）接受了凯利钳挤压肝切除术，22例患者（B组）接受了双极射频设备辅助肝切除术。射频辅助肝切除术与出血量减少（P < 0.0001）、输血率降低（P < 0.005）、手术时间缩短（P < 0.0001）以及术后血清白蛋白水平改善（P < 0.03）相关。这项非随机回顾性研究表明，对于肝功能保留的局灶性肝细胞癌肝硬化患者，射频辅助肝切除术比凯利钳挤压切除技术效果更好。现在应在一项随机临床试验中对这些结果进行前瞻性评估。
