Schemmer Peter, Friess Helmut, Hinz Ulf, Mehrabi Arianeb, Kraus Thomas W, Z'graggen Kaspar, Schmidt Jan, Uhl Waldemar, Büchler Markus W
Department of General Surgery, Ruprecht-Karls-University, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany.
World J Surg. 2006 Mar;30(3):419-30. doi: 10.1007/s00268-005-0192-9.
In many surgical procedures, stapling devices have been introduced for safety and to reduce the overall operative time. Their use for transection of hepatic parenchyma is not well established. Thus, the feasibility of stapler hepatectomy and a risk analysis of surgical morbidity based on intraoperative data have been prospectively assessed on a routine clinical basis.
From October 1, 2001, to January 31, 2005, a total of 416 patients underwent liver resection in our department. During this period endo GIA vascular staplers were used for parenchymal transection in 300 cases of primary (22%) and metastatic (57%) liver cancer, benign diseases (adenoma, focal nodular hyperplasia [FNH], cysts) (14%), gallbladder carcinoma (2%), and other tumors (5%). There were 193 (64%) major resections (i.e., removal of three segments or more) and 107 minor hepatic resections. Additional extrahepatic resections were performed in 44 (15%) patients.
Median values for operative time and intraoperative hemorrhage were 210 minutes and 700 ml, respectively. Further, transfusion of RBC and FFP was needed in 17% and 11% of patients, respectively. A postoperative ICU stay for >2 days was required in 18% of patients. The median postoperative hospital stay was 10 days (IQR 8-14 days). The most frequent surgical complications were bile leak (8%), wound infection (3%), and pneumothorax (2%). In 7% of cases after stapler hepatectomy a relaparotomy was necessary. Treated medical complications were pleural effusion (7%), renal insufficiency (5%), and cardiac insufficiency (3%). Risk assessment revealed that both operative time and indication for resection had significant impact on surgical morbidity. Mortality (4%) and morbidity (33%) were comparable to other high-volume centers performing conventional liver resection techniques.
In conclusion, stapler hepatectomy can be used in a routine clinical setting with a low incidence of surgical complications.
在许多外科手术中，吻合器已被引入以确保安全并缩短总体手术时间。其用于肝实质横断术的应用尚未得到充分确立。因此，我们在常规临床基础上对吻合器肝切除术的可行性以及基于术中数据的手术并发症风险进行了前瞻性评估。
2001年10月1日至2005年1月31日，我院共有416例患者接受了肝切除术。在此期间，300例原发性（22%）和转移性（57%）肝癌、良性疾病（腺瘤、局灶性结节性增生[FNH]、囊肿）（14%）、胆囊癌（2%）及其他肿瘤（5%）患者在肝实质横断术中使用了Endo GIA血管吻合器。其中193例（64%）为大手术（即切除三个及以上肝段），107例为小肝切除术。44例（15%）患者还进行了额外的肝外切除术。
手术时间和术中出血量的中位数分别为210分钟和700毫升。此外，分别有17%和11%的患者需要输注红细胞和新鲜冰冻血浆。18%的患者术后在重症监护病房停留超过2天。术后住院时间中位数为10天（四分位间距8 - 14天）。最常见的手术并发症为胆漏（8%）、伤口感染（3%）和气胸（2%）。7%的吻合器肝切除术后患者需要再次剖腹手术。治疗的内科并发症为胸腔积液（7%）、肾功能不全（5%）和心功能不全（3%）。风险评估显示，手术时间和切除指征均对手术并发症有显著影响。死亡率（4%）和并发症发生率（33%）与其他采用传统肝切除技术的大容量中心相当。
总之，吻合器肝切除术可在常规临床环境中使用，手术并发症发生率较低。
