Rajbabu K, Barber N J, Choi W, Muir G H
Department of Urology, King's College Hospital, London, UK.
Ann R Coll Surg Engl. 2007 May;89(4):359-62. doi: 10.1308/003588407X183418.
The aim of this study was to carry out an independent evaluation of the efficacy and security of a number of vessel ligation devices and ligatures.
A vascular ligation model was devised using fresh, ex vivo porcine internal carotid arteries of varying external diameters. Coloured normal saline was infused via a pressure/monitor device through the artery. The end lumen was occluded by five different techniques: (i) braided suture in a surgeon's knot; (ii) a monofilament suture in a granny knot; (iii) a metallic clip (Ligaclip, Johnson and Johnson); (iv) a bipolar diathermy system (Ligasure, ValleyLab); and (v) an ultrasonically activated scalpel (Harmonic Scalpel, Johnson and Johnson). The vessels were subjected to supraphysiological pressures. Loss of haemostasis was evident by leakage of coloured perfusion fluid.
Secure haemostasis was obtained with all the techniques in all vessels below 5 mm in diameter. In vessels over 5 mm, secure haemostasis was obtained with all modalities except harmonic scalpel. With the harmonic scalpel, leaks occurred in 3/27 (11%) vessels between 5-6 mm and 3/5 (60%) vessels over 6 mm, confirming the manufacturer's instructions.
In this first, independent, randomised study comparing vessel ligation devices and ligatures, the manufacturer's claims for each of the haemostatic methods were accurate. We find that all the modalities tested perform as well as the traditional surgeon's knot in vessels of 5 mm and below.
本研究旨在对多种血管结扎器械和结扎线的有效性和安全性进行独立评估。
使用不同外径的新鲜离体猪颈内动脉设计了一种血管结扎模型。通过压力/监测装置经动脉注入有色生理盐水。采用五种不同技术闭塞血管内腔：（i）外科结中的编织缝线；（ii）奶奶结中的单丝缝线；（iii）金属夹（强生公司的 Ligaclip）；（iv）双极电凝系统（ValleyLab 公司的 Ligasure）；（v）超声刀（强生公司的 Harmonic Scalpel）。使血管承受超生理压力。有色灌注液渗漏表明止血失败。
在所有直径小于 5 毫米的血管中，所有技术均实现了可靠止血。在直径大于 5 毫米的血管中，除超声刀外，所有方式均实现了可靠止血。使用超声刀时，5 - 6 毫米之间的血管中有 3/27（11%）发生渗漏，大于 6 毫米的血管中有 3/5（60%）发生渗漏，证实了制造商的说明。
在这项首次比较血管结扎器械和结扎线的独立随机研究中，每种止血方法的制造商声明都是准确的。我们发现，在直径 5 毫米及以下的血管中，所有测试方式的效果与传统外科结相同。
