Smith David L, Arens James F, Barnett Carlton C, Izzo Francesco, Curley Steven A
Department of Surgical Oncology, 1400 Holcombe Blvd, Unit 444, Houston, TX 77030, USA.
Am J Surg. 2005 Jul;190(1):23-9. doi: 10.1016/j.amjsurg.2004.12.003.
We prospectively evaluated a novel ultrasound-directed technique of major hepatic resection using transparenchymal application of vascular staplers intending to minimize blood loss, operative time, and hepatic warm ischemia time.
Beginning in 1998 many major hepatic resections for hepatic tumors were performed with ultrasound-directed transparenchymal application of vascular linear cutting staplers. An endoscopic flexible neck vascular linear cutting stapler was used for control of the hepatic veins.
From December 1998 to April 2003, 346 patients undergoing hepatic resection using this technique were identified from a prospective hepatobiliary tumor surgery database. Records were reviewed for blood loss, transfusion requirement, inflow occlusion (Pringle maneuver) time, overall operative time, and perioperative and postoperative complications. The average blood loss for all patients was 396 +/- 28.4 mL. The inflow occlusion time was 13.7 +/- .64 minutes with a total operative time of 140.7 +/- 3.7 minutes. Additional liver-related procedures were performed in 52% of the patients. The overall complication rate was 29.5% with a 90-day mortality rate of 1.4%.
Ultrasound-directed transparenchymal application of vascular staplers to control inflow and outflow during major liver resection minimizes blood loss, warm ischemia time, and operative time compared to published reports of patients undergoing resection using other techniques.
我们前瞻性地评估了一种新型超声引导下的肝大部切除术技术，该技术通过肝实质内应用血管吻合器，旨在减少失血、手术时间和肝热缺血时间。
从1998年开始，许多肝肿瘤的肝大部切除术采用超声引导下经肝实质应用血管线性切割吻合器进行。使用内镜柔性颈部血管线性切割吻合器控制肝静脉。
从1998年12月至2003年4月，从一个前瞻性肝胆肿瘤手术数据库中确定了346例采用该技术进行肝切除术的患者。回顾了患者的失血情况、输血需求、入肝血流阻断（Pringle手法）时间、总手术时间以及围手术期和术后并发症。所有患者的平均失血量为396±28.4ml。入肝血流阻断时间为13.7±0.64分钟，总手术时间为140.7±3.7分钟。52%的患者还进行了其他与肝脏相关的手术。总体并发症发生率为29.5%，90天死亡率为1.4%。
与其他技术进行肝切除术的患者的已发表报告相比，超声引导下经肝实质应用血管吻合器在肝大部切除术中控制入肝和出肝血流可减少失血、热缺血时间和手术时间。
