Risselada Marije, Polyak Maximilian M R, Ellison Gary W, Bacon Nicholas J, Van Gilder James M, Coomer Alastair R, Thieman Kelley E
Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610-0126, USA.
Am J Vet Res. 2010 Mar;71(3):262-7. doi: 10.2460/ajvr.71.3.262.
To evaluate postmortem surgery site leakage by use of in situ isolated pulsatile perfusion after partial liver lobectomies.
10 healthy mixed-breed male dogs.
Dogs were anesthetized, and 5 surgical techniques (pretied suture loop, energy-based sealer-divider, harmonic scalpel, suction with clip application, or suction with use of a thoracoabdominal stapler) were used to perform 5 partial liver lobectomies in each dog. Dogs were euthanatized, and the portal vein and hepatic artery were cannulated and perfused with a modified kidney perfusion machine (pulsatile flow for arterial perfusion and nonpulsatile flow for portal perfusion). Lobectomy sites were inspected for leakage of perfusate, and time until detection of leakage was recorded. The techniques in each dog were ranked on the basis of time until leakage. Time until leakage and rankings for each surgical technique were analyzed by use of an ANOVA.
Leakage of perfusate was recorded in 44 lobes at supraphysiologic pressures. Of the 6 lobes without leakage, a pretied suture loop procedure was performed in 5 and a harmonic scalpel procedure was performed in 1. Time until leakage and the ranking differed significantly between the pretied suture loop and the other techniques. Time until leakage and ranking did not differ significantly among the other techniques.
Time until leakage of perfusate was greater for the pretied suture loop technique than for the other techniques, and that technique did not fail in 5 of 10 lobes. However, all techniques appeared to be safe for clinical use.
通过部分肝叶切除术后原位孤立搏动灌注评估尸体手术部位渗漏情况。
10只健康的杂种雄性犬。
对犬实施麻醉，每种手术技术（预打结缝合环、能量型密封切割器、超声刀、夹闭吸引或胸腹吻合器吸引）在每只犬身上进行5次部分肝叶切除术。对犬实施安乐死，将门静脉和肝动脉插管，并用改良的肾脏灌注机进行灌注（动脉灌注为搏动流，门静脉灌注为非搏动流）。检查肝叶切除部位有无灌注液渗漏，并记录渗漏检测时间。根据渗漏前时间对每只犬的手术技术进行排序。使用方差分析对每种手术技术的渗漏前时间和排序进行分析。
在超生理压力下，44个肝叶记录到灌注液渗漏。在6个无渗漏的肝叶中，5个采用预打结缝合环技术，1个采用超声刀技术。预打结缝合环技术与其他技术在渗漏前时间和排序上有显著差异。其他技术在渗漏前时间和排序上无显著差异。
预打结缝合环技术的灌注液渗漏前时间比其他技术长，该技术在10个肝叶中有5个未出现失败情况。然而，所有技术在临床应用中似乎都是安全的。
