Kargozaran Hamed, Wildendorf Stephen, Khatri Vijay P
Department of Surgery, University of California, Davis, Sacramento, California, USA.
Hepatogastroenterology. 2009 Sep-Oct;56(94-95):1496-500.
BACKGROUND/AIMS: Intraoperative bleeding is a major concern in liver surgery and traditionally portal triad clamping (PTC) has been applied to reduce blood loss. However, this benefit is counterbalanced by the adverse effects of warm ischemia-reperfusion liver injury. The ideal alternative would be to use modern energy devices that minimize bleeding, without needing PTC. One such novel device is the InLine multichannel radiofrequency device (ILMRD, Resect Medical, Inc., Fremont, CA) that produces coagulative necrosis along the transection plane.
In the present paper we reviewed 24 consecutive hepatic resections (18 metastases, 5 hepatoma, 1 focal nodular hyperplasia) performed with aid of ILMRD. Statistical analyses were performed with Mann-Whitney and Fisher Exact tests.
The mean blood loss was 240 ml (range 50-750 ml) with only 2 patients requiring blood transfusions. For the first 8 cases the median PTC time was 16 minutes, and in the subsequent 16 cases, not only was there a significant decline in the median clamp time (0 min, p = 0.026) but also in the frequency of PTC use (71% vs. 11%, p = 0.008). A significant reduction in blood loss was seen when comparing the first 8 versus the subsequent 16 cases (median 350 ml vs. 112 ml, p = 0.016). The median length of hospital and intensive care unit stay for the cohort were 7 and 1 days, respectively. There were no deaths and the major morbidity rate was 16.7%.
The use of ILMRD is an innovative approach to minimize blood loss and PTC during parenchymal transection phase of hepatic resection.
背景/目的：术中出血是肝脏手术中的一个主要问题，传统上采用门静脉三联阻断术（PTC）来减少失血。然而，这种益处被温暖缺血-再灌注肝损伤的不良反应所抵消。理想的替代方法是使用能将出血降至最低且无需PTC的现代能量设备。一种这样的新型设备是InLine多通道射频设备（ILMRD，Resect Medical公司，弗里蒙特，加利福尼亚州），它可沿横断平面产生凝固性坏死。
在本文中，我们回顾了借助ILMRD进行的24例连续肝脏切除术（18例转移瘤、5例肝癌、1例局灶性结节性增生）。采用曼-惠特尼检验和费舍尔精确检验进行统计分析。
平均失血量为240毫升（范围50 - 750毫升），仅2例患者需要输血。前8例患者的PTC中位时间为16分钟，在随后的16例患者中，不仅中位阻断时间显著下降（0分钟，p = 0.026），而且PTC的使用频率也显著下降（71%对11%，p = 0.008）。比较前8例与随后16例患者时，失血量显著减少（中位失血量分别为350毫升对112毫升，p = 0.016）。该队列患者的中位住院时间和重症监护病房停留时间分别为7天和1天。无死亡病例，主要发病率为16.7%。
使用ILMRD是一种在肝脏切除实质横断阶段将失血和PTC降至最低的创新方法。
