Milićević Miroslav, Bulajić Predrag, Zuvela Marinko, Dervenis Christos, Basarić Dragan, Galun Danijel
The First Surgical Clinic, Institute for Digestive Diseases, University Clinical Center of Belgrade, Belgrade, Serbia.
Dig Surg. 2007;24(4):306-13. doi: 10.1159/000103663.
BACKGROUND/AIMS: Intraoperative blood loss is still a major concern for surgeons operating on the liver since it is associated with a significantly higher rate of postoperative complications and shorter long-term survival. An original radiofrequency (RF)-assisted minimal blood loss technique for transecting liver parenchyma is presented.
In a prospective study, starting November 2001 and ending December 2005, a total of 90 RF-assisted liver resections were done. Pre-cut coagulative desiccation was produced by the Cool-tip (Valleylab, Tyco) water-cooled, single, RF tumor ablation electrode connected to a 480-kHz 200 W generator (Valleylab Cool-tip RF System). Vascular occlusion techniques and low central venous pressure anesthesia were not used.
Only 14 (15.5%) patients received blood transfusion (mean transfused blood volume 397 ml; mode 310 ml) and 10 of 14 patients received <310 ml of blood. There was no statistical difference between the patients who underwent major and minor liver resection in frequency of blood transfusion. Blood loss was associated with dense adhesions and difficult liver mobilization and not with liver transection.
The 'sequential coagulate-cut' RF-assisted liver resection technique is a safe liver transection technique associated with minimal blood loss and it has facilitated tissue-sparing liver resection.
背景/目的：术中失血仍是肝脏手术外科医生主要关注的问题，因为它与术后并发症发生率显著升高及长期生存率降低相关。本文介绍一种用于肝实质离断的原创性射频（RF）辅助微创失血技术。
在一项前瞻性研究中，从2001年11月开始至2005年12月结束，共进行了90例RF辅助肝切除术。预切割凝固干燥由连接到480 kHz 200 W发生器（Valleylab Cool-tip RF系统）的Cool-tip（Valleylab，泰科）水冷单极RF肿瘤消融电极产生。未使用血管阻断技术和低中心静脉压麻醉。
仅14例（15.5%）患者接受输血（平均输血量397 ml；众数310 ml），14例患者中有10例接受的输血量<310 ml。接受大肝切除和小肝切除的患者在输血频率上无统计学差异。失血与致密粘连和肝脏游离困难有关，而与肝实质离断无关。
“顺序凝固-切割”RF辅助肝切除技术是一种安全的肝实质离断技术，失血极少，有助于保留组织的肝切除术。
