Guastella T, Baer H U, Maddern G J, Blumgart L H
Klinik für Viszerale und Transplantationschirurgie, Universität Bern, SCHWEIZ.
Ann Ital Chir. 1992 Mar-Apr;63(2):187-91; discussion 191-2.
Increasing experience with major hepatic resections has stimulated the development of improved resectional techniques and tools. The authors describe a recently developed high pressure, high velocity water jet which offers significant advantages over previously developed methods like ultrasonic dissectors and low pressure water jet machines. The pressure of the system is significantly elevated (between 200 and 600 Bars) and the ejection speed is over 300 m/sec. although the flux remains low. It has been successfully used in 22 major hepatic resections (2 left hepatectomy, 4 extended left, 3 right, 8 extended right and 5 segmental resections) and also during 6 peripheral biliodigestive bypasses (3 segment III bypasses and 3 peripheral segment III bypasses). The blood loss was low and the visibility excellent. The amount of fluid required by the instrument was small reducing the risk of complications. Previous report demonstrated that the water jets are more effective when compared with ultrasound dissectors. The technical characteristic of the new high pressure water jet improves on those intrinsic qualities allowing a more rapid dissection of both fibrous and normal parenchyma and simplifying the use of the instrument. The authors conclude that the new high pressure, high velocity water jet is an effective tool for biliodigestive surgery.
随着对大型肝切除术经验的不断增加，促使了改进的切除技术和工具的发展。作者描述了一种最近开发的高压、高速水刀，与先前开发的方法如超声解剖器和低压水刀相比，它具有显著优势。该系统的压力显著提高（在200至600巴之间），喷射速度超过300米/秒，尽管流量仍然较低。它已成功应用于22例大型肝切除术（2例左肝切除术、4例扩大左肝切除术、3例右肝切除术、8例扩大右肝切除术和5例节段性切除术）以及6例周围胆肠吻合术（3例Ⅲ段吻合术和3例周围Ⅲ段吻合术）。术中失血少，视野清晰。该器械所需的液体量少，降低了并发症风险。先前的报告表明，与超声解剖器相比，水刀更有效。新型高压水刀的技术特性改进了其固有品质，能够更快地分离纤维组织和正常实质，简化了器械的使用。作者得出结论，新型高压、高速水刀是胆肠手术的有效工具。
