免夹胆囊切除术：拓展超声刀的应用范围
Clipless cholecystectomy: broadening the role of the harmonic scalpel.
作者信息
Westervelt James
机构信息
Clark Memorial Hospital, Jeffersonville, Indiana, USA.
出版信息
JSLS. 2004 Jul-Sep;8(3):283-5.
BACKGROUND
The ultrasonically activated (Harmonic) scalpel has proven to be an effective, efficient, and safe instrument for dissection and hemostasis in both open and laparoscopic surgical procedures. To date, the primary use of the Harmonic scalpel in laparoscopic cholecystectomies has been for the division of the cystic artery and liver bed dissection. Advancements in the Harmonic scalpel blade tip now provide for the reliable ultrasonic division and closure of the cystic duct.
METHODS
In a personal, prospective series involving 100 consecutive patients undergoing laparoscopic cholecystectomies, the Harmonic scalpel was used as the sole instrument for division of the cystic duct and artery as well as dissection of the liver bed. Two patients with large cystic ducts (over 5 mm) received an additional ductal ligature.
RESULTS
No patients developed postoperative hemorrhage or bile leakage.
CONCLUSION
The Harmonic scalpel provides complete hemobiliary stasis for most patients and is a safe alternative to standard clip or ligature closure of the cystic duct. Furthermore, there may be a cost savings inherent in a procedure utilizing a single disposable instrument.
背景
超声刀已被证明是一种在开放手术和腹腔镜手术中进行解剖和止血的有效、高效且安全的器械。迄今为止，超声刀在腹腔镜胆囊切除术中的主要用途是用于胆囊动脉的离断和肝床的解剖。超声刀刀头的改进现在使得胆囊管的可靠超声离断和闭合成为可能。
方法
在一项个人前瞻性系列研究中，连续100例接受腹腔镜胆囊切除术的患者，超声刀被用作离断胆囊管和动脉以及解剖肝床的唯一器械。两名胆囊管粗大（超过5毫米）的患者额外进行了胆管结扎。
结果
无患者发生术后出血或胆漏。
结论
超声刀可为大多数患者提供完全的血胆停滞，是胆囊管标准夹闭或结扎闭合的一种安全替代方法。此外，使用单一一次性器械的手术可能存在成本节约。
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