Arita J, Hasegawa K, Kokudo N, Sano K, Sugawara Y, Makuuchi M
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
Br J Surg. 2005 Aug;92(8):954-9. doi: 10.1002/bjs.5108.
Use of a saline-linked radiofrequency coagulator (dissecting sealer) has been suggested to reduce blood loss during hepatic resection. A randomized clinical trial was conducted to assess the effects of using the device on the amount of blood loss.
Patients scheduled to undergo hepatic resection were randomly assigned to either use of the dissecting sealer or the clamp crushing method. The primary outcome measure was blood loss during liver parenchymal division. Multivariate analysis was also performed.
Ninety-four consecutive patients underwent hepatic resection and 40 patients were assigned to each group. There were no significant differences between the dissecting sealer and clamp crushing groups in blood loss during liver parenchymal division (median 373 versus 535 ml; P = 0.252) or total intraoperative blood loss (665 versus 733 ml; P = 0.450). Multivariate analysis revealed that use of the dissecting sealer offered no protection against blood loss compared with the clamp crushing method (odds ratio 1.17 (95 per cent confidence interval 0.39 to 3.53); P = 0.777), whereas number of resections, thoracotomy and type of resection had a significant effect.
Use of a dissecting sealer offered no substantial benefit over the clamp crushing method in reducing blood loss during hepatic resection.
有人提出使用盐水连接射频凝固器（解剖闭合器）可减少肝切除术中的失血。进行了一项随机临床试验，以评估使用该设备对失血量的影响。
计划接受肝切除术的患者被随机分配使用解剖闭合器或钳夹压榨法。主要观察指标是肝实质离断期间的失血量。还进行了多变量分析。
94例连续患者接受了肝切除术，每组分配40例患者。解剖闭合器组与钳夹压榨组在肝实质离断期间的失血量（中位数分别为373 ml和535 ml；P = 0.252）或术中总失血量（665 ml和733 ml；P = 0.450）方面无显著差异。多变量分析显示，与钳夹压榨法相比，使用解剖闭合器对减少失血没有保护作用（比值比1.17（95%置信区间0.39至3.53）；P = 0.777），而切除数量、开胸手术和切除类型有显著影响。
在减少肝切除术中的失血方面，使用解剖闭合器与钳夹压榨法相比没有实质性益处。
