Ayodeji I D, Hop W C J, Tetteroo G W M, Bonjer H J, de Graaf E J R
Department of Surgery, Erasmus Medical Center, Dr. Molewaterplein 40, Rotterdam, 3015, GD, The Netherlands.
Surg Endosc. 2004 Dec;18(12):1730-7. doi: 10.1007/s00464-003-9331-2. Epub 2004 Oct 26.
For transanal endoscopic microsurgery, the ultracision Harmonic Scalpel (UC) and the multifunctional TEM400 instrument (T400) seem advantageous. This study investigated their clinical use.
Prospective analysis of tumor, patient, and operation characteristics was performed for 196 tumor resections per instrument intended for application.
The T400 instrument was applied in 162 operations, and the UC in 34 operations. Tumor and patient characteristics were similar except for tumor area (respectively, 7.5 and 17 cm(2); p = 0.003). Operative time was proportionate to the tumor area (p < 0.001) and inversely proportionate to its distance from the dentate line to the lower margin of the tumor of the UC (p = 0.002). Application reduced operative time by 26% (p = 0.02, corrected for area). Whereas, T400 was always singly sufficient for excision, the UC required T400 application in 50% of operations, especially for larger tumors (p = 0.026), with the result that more rectal wall circumference was captured (p = 0.043). Both groups had similar safety parameters.
The UC substantially reduced operative time compared with the T400, but frequently required the T400 for procedure completion. The T400 is always singly sufficient.
对于经肛门内镜显微手术，超声刀（UC）和多功能TEM400器械（T400）似乎具有优势。本研究调查了它们的临床应用情况。
对每种器械计划应用的196例肿瘤切除术的肿瘤、患者及手术特征进行前瞻性分析。
T400器械应用于162例手术，UC应用于34例手术。除肿瘤面积外（分别为7.5和17平方厘米；p = 0.003），肿瘤和患者特征相似。手术时间与肿瘤面积成正比（p < 0.001），与超声刀从齿状线到肿瘤下缘的距离成反比（p = 0.002）。应用超声刀可使手术时间缩短26%（p = 0.02，经面积校正）。然而，T400单独使用总是足以完成切除，而超声刀在50%的手术中需要联合使用T400，尤其是对于较大肿瘤（p = 0.026），结果是切除的直肠壁周长更大（p = 0.043）。两组的安全参数相似。
与T400相比，超声刀显著缩短了手术时间，但经常需要联合T400才能完成手术。T400单独使用总是足够的。
