Campagnacci R, De Sanctis A, Baldarelli M, Di Emiddio M, Organetti L, Nisi M, Lezoche G, Guerrieri M
Clinica di Chirurgia Generale e Metodologia Chirurgica, Ospedali Riuniti, University of Ancona, Ancona, Italy.
Surg Endosc. 2007 Dec;21(12):2280-4. doi: 10.1007/s00464-007-9384-8. Epub 2007 May 19.
Many techniques and devices are available for performing liver resection, such as clamp crushing, Cavitron Ultrasonic Surgical Aspirator (CUSA), Hydrojet and dissecting sealer, ultrasonic shears, and, more recently, electrothermal bipolar vessel sealing system (EBVS). In this prospective trial we sought to evaluate the impact of EBVS on hepatic resections.
From March 2004 to December 2005, 24 patients from our consecutive liver resection series were enrolled in the present study. There were 17 males and 7 females with a mean age of 59.6 years (range = 41-80) who had colonic cancer metastases (18), hepatocarcinoma (3), angioma (2), and intrahepatic lithisasis (1). Patients were prospectively randomized to undergo liver resection via EBVS LigaSure V (12 patients, group A) or ultrasonic shears harmonic scalpel (HS) (12 patients, group B). Hepatic procedures did not differ significantly between the two groups and were as follows: right hepatectomy (2), left hepatectomy (1), bisegmentectomy (14), and segmentectomy (7).
There was no mortality in either group. The mean operative time was 136.7 min (range = 90-210) in group A and 187.9 min (range = 130-360) in group B. The Pringle maneuver was done in five patients in group A [mean time = 11.4 min (range = 6-12)] and in four patients in group B [mean time = 16 min (range = 9-26)]. The mean blood loss, total bile salts, and hemoglobin concentration from drained fluid on the second postoperative day were 205.8 vs. 506.7 ml, 0.6 vs. 1.1 mmol/L, and 1.0 vs. 2.1 g/L (p < 0.05) for groups A and B, respectively. Mean postoperative hospital stay was 6.1 vs. 7.8 days. In group B a patient who underwent right hepatectomy for colon cancer metastases had transient hepatic failure. No patients received blood transfusions in group A, while two or more blood units were administered in two cases in group B.
In the present study EBVS proved to be safe and effective for liver resection. By means of this device, statistically significant benefits concerning blood loss, total bile salts, and hemoglobin postoperative leakage were found.
有多种技术和设备可用于肝切除术，如钳夹挤压、超声外科吸引器（CUSA）、水刀和解剖闭合器、超声刀，以及最近出现的电热双极血管闭合系统（EBVS）。在这项前瞻性试验中，我们试图评估EBVS对肝切除术的影响。
从2004年3月至2005年12月，我们连续肝切除系列中的24例患者被纳入本研究。其中男性17例，女性7例，平均年龄59.6岁（范围41 - 80岁），患有结肠癌转移（18例）、肝癌（3例）、血管瘤（2例）和肝内结石（1例）。患者被前瞻性随机分为两组，分别通过EBVS LigaSure V进行肝切除（12例，A组）或超声刀（谐波手术刀，HS）进行肝切除（12例，B组）。两组的肝脏手术操作无显著差异，具体如下：右肝切除术（2例）、左肝切除术（1例）、双段切除术（14例）和段切除术（7例）。
两组均无死亡病例。A组平均手术时间为136.7分钟（范围90 - 210分钟），B组为187.9分钟（范围130 - 360分钟）。A组5例患者进行了Pringle手法操作[平均时间 = 11.4分钟（范围6 - 12分钟）]，B组4例患者进行了该操作[平均时间 = 16分钟（范围9 - 26分钟）]。术后第二天引流液中的平均失血量、总胆汁盐和血红蛋白浓度，A组分别为205.8 ml与506.7 ml、0.6 mmol/L与1.1 mmol/L、1.0 g/L与2.1 g/L（p < 0.05）。平均术后住院时间分别为6.1天与7.8天。B组中1例因结肠癌转移接受右肝切除术的患者出现了短暂性肝衰竭。A组无患者接受输血，而B组有2例患者接受了两个或更多单位的输血。
在本研究中，EBVS被证明用于肝切除术是安全有效的。通过该设备，在失血量、总胆汁盐和术后血红蛋白渗漏方面发现了具有统计学意义的益处。
