Section of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Washington University, Saint Louis, MO 63110, USA.
HPB (Oxford). 2009 May;11(3):258-63. doi: 10.1111/j.1477-2574.2009.00048.x.
This study aimed to evaluate if the Gyrus open forceps is a safe and efficient tool for hepatic parenchymal transection.
Blood loss during hepatic transection remains a significant risk factor for morbidity and mortality associated with liver surgery. Various electrosurgical devices have been engineered to reduce blood loss. The Gyrus open forceps is a bipolar cautery device which has recently been introduced into hepatic surgery.
We conducted a single-institution, retrospective review of all liver resections performed from November 2005 through November 2007. Patients undergoing resection of at least two liver segments where the Gyrus was the primary method of transection were included. Patient charts were reviewed; clinicopathological data were collected.
Of the 215 open liver resections performed during the study period, 47 patients met the inclusion criteria. Mean patient age was 61 years; 34% were female. The majority required resection for malignant disease (94%); frequent indications included colorectal metastasis (66%), hepatocellular carcinoma (6%) and cholangiocarcinoma (4%). Right hemihepatectomy (49%), left hemihepatectomy (13%) and right trisectionectomy (13%) were the most frequently performed procedures. A total of 26 patients (55%) underwent a major ancillary procedure concurrently. There were no operative mortalities. Median operative time was 220 min (range 97-398 min). Inflow occlusion was required in nine patients (19%) for a median time of 12 min (range 3-30 min). Median total estimated blood loss was 400 ml (range 10-2000 ml) and 10 patients (21%) required perioperative transfusion. All patients had macroscopically negative margins. Median length of stay was 8 days. Two patients (4%) had clinically significant bile leak. The 30-day postoperative mortality was zero.
Use of the Gyrus open forceps appears to be a safe and efficient manner of hepatic parenchymal transection which allows rapid transection with acceptable blood loss, a low rate of perioperative transfusion, and minimal postoperative bile leak.
本研究旨在评估 Gyrus 开颅器在肝实质切开中的安全性和有效性。
肝切除术中的出血仍然是与肝外科相关的发病率和死亡率的重要危险因素。各种电外科设备已被设计用于减少出血。Gyrus 开颅器是一种双极电烙器，最近已被引入肝外科。
我们对 2005 年 11 月至 2007 年 11 月期间进行的所有肝切除术进行了单中心回顾性研究。纳入至少切除两个肝段且主要采用 Gyrus 进行切开的患者。回顾患者病历，收集临床病理资料。
在研究期间进行的 215 例开放性肝切除术中，47 例患者符合纳入标准。患者平均年龄 61 岁，女性占 34%。大多数患者因恶性疾病需要切除（94%）；常见的适应证包括结直肠癌转移（66%）、肝细胞癌（6%）和胆管癌（4%）。右半肝切除术（49%）、左半肝切除术（13%）和右三叶切除术（13%）是最常进行的手术。共有 26 例（55%）患者同时进行了主要辅助手术。无手术死亡。中位手术时间为 220 分钟（97-398 分钟）。9 例（19%）患者需要入肝血流阻断，中位阻断时间为 12 分钟（3-30 分钟）。中位总估计出血量为 400ml（10-2000ml），10 例（21%）患者需要围手术期输血。所有患者均获得了宏观阴性切缘。中位住院时间为 8 天。2 例（4%）患者出现临床显著胆漏。术后 30 天死亡率为零。
使用 Gyrus 开颅器进行肝实质切开似乎是一种安全有效的方法，可快速切开，出血量可接受，围手术期输血率低，术后胆漏发生率低。
