Application of radiofrequency ablation in liver resection for hepatic cancer / 中华消化外科杂志

ABSTRACT

Objective To compare the effects of radiofrequency ablation and clamp crushing resection on intraoperative blood loss and postoperative complications.Methods The clinical data of 130 patients with hepatic cancer who were admitted to the Southwest Hospital from January 2011 to June 2012 were retrospectively analyzed.Sixty-five patients who received radiofrequency ablation were in the radiofrequency ablation group; the clinical data of 65 hepatic cancer patients with similar tumor size,position and Child-Pugh scores who received traditional clamp crushing resection were selected from the data base,and they were in the clamp crushing resection group.The intra-and postoperative clinical data of the 2 groups were statistically analyzed.The measurement data were presented in the format of median plus range,and were analyzed using the analysis of variance; the enumeration data were analyzed using chi-square test,when the number of patients was under 10,the Fisher exact probability was used for analysis.Results The time for liver resection and hepatic inflow occlusion in the radiofrequency ablation group were 28 minutes (range,12-55 minutes) and 10 minutes (range,0-15 minutes),which were significantly shorter than 45 minutes (range,25-92 minutes) and 15 minutes (range,10-32 minutes) in the clamp crushing resection group (F =10.35,9.05,P ＜0.05).The volumes of intraoperative blood loss and blood transfusion were 150 ml (range,50-350 ml) and 0 ml in the radiofrequency ablation group,which were significantly lesser than 450 ml (range,250-2500 ml) and 550 ml (range,0-2000 ml) in the clamp crushing resection group (F =15.86,P ＜ 0.05).The number of patients who did not receive blood transfusion in the radiofrequency ablation group was 65,which was significantly greater than 48 in the clamp crushing resection group (x2 =19.58,P ＜ 0.05).The levels of aspartic transaminase (AST) and total bilirubin (TBil) at postoperative day 3 and 7,prothrombin time (PT) at postoperative day 3,Clavien classification of surgical complications,duration of hospital stay were 302 U/L (range,89-823 U/L),54 U/L (range,16-325 U/L),37 μmol/L(range,18-112 μmol/L),24 μmol/L (range,9-66 μmol/L),15 s (range,11-20 s),22％ (14/65),12 days (range,8-36 days) in the radiofrequency ablation group,and 253 U/L (range,63-876 U/L),62 U/L(range,22-376 U/L),41 μmol/L (range,19-105 μmol/L),25 μmol/L (range,11-59 μmol/L),14 s (range,11-21 s),26％ (17/65) and 13 days (range,9-35 days) in the clamp crushing resection group.There were no significant differences in the 7 indexes between the radiofrequency ablation group and the clamp crushing resection group (F=2.59,1.93,3.96,1.58,2.35,x2 =0.381,F=1.58,P＞0.05).The incidence of complications of the radiofrequency ablation group was 17％ (11/65),which was significantly lower than 52％ (34/65) of the clamp crushing resection group (x2 =17.38,P ＜ 0.05).The number of patients who had postoperative bleeding in the radiofrequency ablation group was 2,which was significantly lesser than 22 patients in the clamp crushing resection group.Eight patients in the radiofrequency ablation group had encapsulated effusion,and 5 of them need drainage.Two patients in the clamp crushing resection group had hepatic insufficiency.Two patients in the radiofrequency ablation group had hemoglobinuria.Conclusion Compared with clamp crushing resection,radiofrequency ablation has advantages of less blood loss and safer manipulation.