Shamiyeh A, Schrenk P, Tulipan L, Vattay P, Bogner S, Wayand W
Ludwig Boltzmann Institute for Operative Laparoscopy and 2nd Surgical Department, General Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria.
Surg Endosc. 2002 May;16(5):812-3. doi: 10.1007/s00464-001-9058-x. Epub 2002 Feb 8.
Bile leaks are serious complications after laparoscopic cholecystectomy. The aim of this study was to evaluate the feasibility of closure of the cystic duct with a new feedback-controlled bipolar sealing system (LigaSure).
Ten domestic pigs underwent open cholecystectomy with the cystic duct and artery dissected and sealed with the new bipolar sealing system (LigaSure). Four and 8 days postoperatively, 5 pigs each were sacrificed and the closure of the cystic duct was evaluated. The cystic stump and the common bile duct were excised for histological examination.
None of the pigs had a bile leak or a biliary peritonitis. There were no signs of postoperative bleeding or inflammation in Calot's triangle. Histology showed total necrosis of the cystic duct in the first two pigs due to too much energy used. The remaining specimens showed a regularly scaling zone without necrosis in 7 cases, and in one case a partial necrosis in the mucosa only was found.
Cystic artery and cystic duct closure with the new device may be an alternative to the clip. Further trials should evaluate the feasibility and safety of the new device in the clinical setting.
胆漏是腹腔镜胆囊切除术后的严重并发症。本研究的目的是评估使用新型反馈控制双极密封系统（LigaSure）闭合胆囊管的可行性。
对10头家猪进行开腹胆囊切除术，用新型双极密封系统（LigaSure）分离并封闭胆囊管和动脉。术后4天和8天，分别处死5头猪，评估胆囊管的闭合情况。切除胆囊残端和胆总管进行组织学检查。
所有猪均未发生胆漏或胆汁性腹膜炎。胆囊三角区无术后出血或炎症迹象。组织学检查显示，前两头猪因能量使用过多导致胆囊管完全坏死。其余标本中，7例显示有规则的结痂区且无坏死，1例仅发现黏膜部分坏死。
使用新装置闭合胆囊动脉和胆囊管可能是夹闭法的一种替代方法。进一步的试验应评估该新装置在临床环境中的可行性和安全性。
