Richter Sven, Kollmar Otto, Neunhoeffer Eva, Schilling Martin K, Menger Michael D, Pistorius Georg
Department of General, Visceral, Vascular, and Pediatric Surgery, University of Saarland, Homburg, Germany.
J Laparoendosc Adv Surg Tech A. 2006 Apr;16(2):149-55. doi: 10.1089/lap.2006.16.149.
A variety of energy-based techniques for arterial and venous vessel ligation have recently been introduced. Using a porcine model we studied the efficacy of the novel reusable BiClamp versus the standard disposable LigaSure bipolar vessel sealing device. We also compared whether arteries respond differently than veins upon sealing.
In five Swabian Hall pigs, splenectomy and nephrectomy were performed using two different bipolar vessel sealing devices. Measurements of the sealed arteries and veins (diameter 2-7 mm) included rate of seal failure, burst strength, and heat-associated vascular wall morphologic appearance. An additional three animals underwent splenectomy, salpingo-oophorectomy, and small bowel resection, and vessel seals were studied histologically after a seven-day survival period for vessel wall fusion, inflammation, and fibrous organization.
Sealing was highly successful, with only one seal failure overall and thus no difference between the two instruments analyzed. The burst pressures of BiClamp-sealed arteries (842 +/- 117 mm Hg) did not differ from that of arteries sealed with LigaSure (856 +/- 102 mm Hg), but were significantly higher than the burst pressures of veins (155 +/- 26 and 216 +/- 71 mm Hg, respectively) (P < 0.05). Independent of the sealing device used, thermal spread was found increased in veins compared to arteries. Histologic analysis after seven days revealed appropriate healing of the vessel wall, including thrombus fibrosis, fibroblast proliferation, and collagen deposition. With both devices, however, the venous but not the arterial walls still presented with massive inflammatory cell infiltrates.
Our study indicates that the BiClamp device is as appropriate as the LigaSure instrument to successfully ligate 2-7 mm arteries and veins, demonstrating supraphysiological bursting strengths and adequate lumenal fusion healing. However, veins are more prone to collateral tissue damage and inflammatory wall infiltration.
最近引入了多种基于能量的动静脉血管结扎技术。我们使用猪模型研究了新型可重复使用的BiClamp与标准一次性LigaSure双极血管闭合装置的疗效。我们还比较了动脉和静脉在闭合时的反应是否不同。
在5只施瓦本哈尔猪中，使用两种不同的双极血管闭合装置进行脾切除术和肾切除术。对闭合的动脉和静脉（直径2 - 7毫米）的测量包括闭合失败率、破裂强度和与热相关的血管壁形态外观。另外3只动物接受了脾切除术、输卵管卵巢切除术和小肠切除术，并在存活7天后对血管闭合处进行组织学研究，观察血管壁融合、炎症和纤维组织形成情况。
闭合非常成功，总体仅出现1次闭合失败，因此所分析的两种器械之间无差异。BiClamp闭合的动脉破裂压力（842±117毫米汞柱）与LigaSure闭合的动脉破裂压力（856±102毫米汞柱）无差异，但显著高于静脉的破裂压力（分别为155±26和216±71毫米汞柱）（P<0.05）。与所使用的闭合装置无关，发现静脉中的热扩散比动脉中增加。7天后的组织学分析显示血管壁愈合良好，包括血栓纤维化、成纤维细胞增殖和胶原沉积。然而，使用两种装置时，静脉壁而非动脉壁仍有大量炎性细胞浸润。
我们的研究表明，BiClamp装置与LigaSure器械一样适合成功结扎2 - 7毫米的动脉和静脉，显示出超生理的破裂强度和足够的管腔融合愈合。然而，静脉更容易发生侧支组织损伤和炎性壁浸润。
