Oertel Joachim, Gaab Michael Robert, Runge Uwe, Schroeder Henry Werner Siegfried, Piek Juergen
Department of Neurosurgery, Hannover Nordstadt Hospital, Haltenhoffstrasse 41, Hannover, Germany.
Neurosurgery. 2005 Jan;56(1 Suppl):142-6; discussion 142-6. doi: 10.1227/01.neu.0000144316.87764.13.
Waterjet dissection is currently under close investigation in neurosurgery. Experimentally, precise brain parenchyma dissection with vessel preservation has been demonstrated. Clinically, the safety of the instrument has already been proved. However, precise data demonstrating that waterjet dissection indeed reduces surgical blood loss are still missing.
The authors applied the waterjet device in a prospective randomized study in comparison with the ultrasonic aspirator. Because there is little variability in the procedure, 30 patients with temporal lobe epilepsy receiving a tailored temporal lobe resection between December 1999 and October 2002 were selected for this study. Intraoperative vessel preservation, intraoperative blood loss, surgical complications, and epilepsy outcome were evaluated. All patients were followed at 3-month intervals.
During surgery, both instruments were easy to handle. Only with the waterjet dissector, however, were even small intraparenchymal blood vessels preserved. Intraoperative blood loss was significantly reduced with the waterjet (mean, 70 +/- 46 ml) compared with the ultrasonic aspirator (mean, 121 +/- 48 ml). However, no difference in the necessity for blood transfusion occurred. No difference was observed with respect to operation time (238.6 +/- 37.0 min with the waterjet, 247.5 +/- 41.5 min with the ultrasonic aspirator), surgical complications, and outcome.
The waterjet dissector enables a significant reduction of intraoperative blood loss in the investigated setting. However, further studies are needed to confirm these results with a larger number of patients. Studies also are needed to prove that the reduction of blood loss is of clinical relevance for the outcome of the patients.
水刀分离术目前正在神经外科领域接受密切研究。实验表明，使用水刀可在保留血管的情况下精确分离脑实质。在临床应用中，该器械的安全性已得到证实。然而，仍缺乏确切数据证明水刀分离术确实能减少手术出血量。
作者进行了一项前瞻性随机研究，将水刀设备与超声吸引器进行对比应用。由于该手术的变异性较小，选取了1999年12月至2002年10月期间30例接受颞叶切除术治疗颞叶癫痫的患者进行本研究。评估术中血管保留情况、术中出血量、手术并发症及癫痫治疗效果。所有患者每3个月随访一次。
手术过程中，两种器械操作均简便。然而，只有使用水刀分离器才能保留脑实质内的细小血管。与超声吸引器相比，水刀组术中出血量显著减少（水刀组平均为70±46 ml，超声吸引器组平均为121±48 ml）。但在输血必要性方面无差异。在手术时间（水刀组为238.6±37.0分钟，超声吸引器组为247.5±41.5分钟）、手术并发症及治疗效果方面未观察到差异。
在所研究的情况下，水刀分离器可显著减少术中出血量。然而，需要进一步研究以纳入更多患者来证实这些结果。还需要进行研究以证明减少出血量对患者治疗效果具有临床意义。
