Wang Wen-Xi, Fan Sheung-Tat
Centre for the Study of Liver Disease and Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China.
Asian J Surg. 2003 Oct;26(4):193-6. doi: 10.1016/S1015-9584(09)60301-8.
The aim of this study was to analyse the outcome of hepatectomy using the Endo-GIA vascular stapler and to derive a strategy to avoid complications from its use.
From October 1998 to December 2001, 156 patients underwent major hepatectomy for hepatocellular carcinoma. There were 124 men and 32 women, with a median age of 52.5 years. The Endo-GIA vascular stapler was used for division of the hepatic vein and hepatic duct. Intra- and postoperative clinical data were evaluated.
The overall morbidity and mortality rates were 32.1% and 8.3%, respectively. Seventy-six percent of patients did not require blood transfusion. The median blood loss volume was 1 L. There were no complications related to the use of the Endo-GIA vascular stapler in dividing the hepatic veins. One patient (0.6%) had a complication from the use of the stapler for right hepatic duct transection and recovered uneventfully after hepaticojejunostomy. Intraoperative cholangiography was performed in subsequent patients undergoing right trisegmentectomy to avoid biliary complications.
The Endo-GIA vascular stapler is a safe and useful tool to divide the hepatic vein, but surgeons should exercise particular caution to avoid complications when it is used for hepatic duct division.
本研究旨在分析使用Endo - GIA血管吻合器进行肝切除术的结果，并得出避免因使用该器械而引发并发症的策略。
1998年10月至2001年12月，156例患者因肝细胞癌接受了大肝切除术。其中男性124例，女性32例，中位年龄为52.5岁。使用Endo - GIA血管吻合器离断肝静脉和肝管。对术中及术后临床数据进行评估。
总体发病率和死亡率分别为32.1%和8.3%。76%的患者无需输血。中位失血量为1升。在使用Endo - GIA血管吻合器离断肝静脉过程中未出现并发症。1例患者（0.6%）在使用吻合器离断右肝管时出现并发症，行肝管空肠吻合术后顺利康复。随后对接受右三段切除术的患者进行术中胆管造影以避免胆道并发症。
Endo - GIA血管吻合器是离断肝静脉的一种安全且有用的工具，但外科医生在使用其离断肝管时应格外小心以避免并发症。
