Risselada Marije, Ellison Gary W, Bacon Nicholas J, Polyak Maximilian M R, van Gilder Jim, Kirkby Kristin, Kim Stanley E
Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610-0126, USA.
Vet Surg. 2010 Oct;39(7):856-62. doi: 10.1111/j.1532-950X.2010.00719.x.
To compare surgical time and intraoperative blood loss for 5 partial liver lobectomy techniques in the dog.
Experimental in vivo study.
Dogs (n=10).
Five surgical techniques (SurgiTie(™) ; LigaSure(™) ; Ultracision(®) Harmonic Scalpel [UAS]; Suction+Clip; Suction+thoracoabdominal stapler [TA]) for partial liver lobectomy in dogs were evaluated and compared for total surgical time and intraoperative blood loss. Body weight, activated clotting time (ACT), heart rate, and intraoperative blood pressure (BP) were recorded. Blood loss was determined by adding the weight of the blood soaked sponges during surgery (1 g=1 mL) to the amount of suctioned blood (mL). Surgical time (in seconds) was determined from the start of the lobectomy until cessation of bleeding from the stump. Mean surgical time and mean blood loss for each technique were compared using a Tukey's multiple comparison test.
No significant differences were found between dogs for weight, ACT, heart rate, and intraoperative BP. No complications were seen with the SurgiTie(™) technique in 9 of 10 cases. There was no significant difference in surgical time between techniques however there was a significant difference for blood loss; the Suction+Clip method had significantly more blood loss than the other techniques.
Skeletonization of the lobar vessels before individually clipping them (Suction+Clip) resulted in a higher blood loss than using Suction+TA, UAS, SurgiTie(™) or the LigaSure(™) device. The SurgiTie(™) appears to be an acceptable method for partial liver lobectomy.
Although skeletonization and individually clipping the vessels had the highest blood loss, it still was <7.5% of total blood volume. All 5 techniques should be safe for clinical use in small to medium sized dogs up to 26 kg.
比较犬的5种部分肝叶切除术技术的手术时间和术中失血量。
体内实验研究。
犬（n = 10）。
评估并比较犬部分肝叶切除术的5种手术技术（外科结扎带（SurgiTie™）；血管闭合系统（LigaSure™）；超声刀（Ultracision® Harmonic Scalpel [UAS]）；吸引+夹子；吸引+胸腹吻合器[TA]）的总手术时间和术中失血量。记录体重、活化凝血时间（ACT）、心率和术中血压（BP）。失血量通过将手术期间浸湿海绵的血液重量（1 g = 1 mL）与吸引的血液量（mL）相加来确定。手术时间（以秒为单位）从肝叶切除术开始到残端出血停止来确定。使用Tukey多重比较检验比较每种技术的平均手术时间和平均失血量。
犬之间在体重、ACT、心率和术中BP方面未发现显著差异。10例中有9例采用外科结扎带（SurgiTie™）技术未出现并发症。技术之间手术时间无显著差异，但失血量有显著差异；吸引+夹子方法的失血量明显多于其他技术。
在单独夹闭叶血管之前进行血管骨骼化处理（吸引+夹子）导致的失血量高于使用吸引+TA、UAS、外科结扎带（SurgiTie™）或血管闭合系统（LigaSure™）装置。外科结扎带（SurgiTie™）似乎是部分肝叶切除术的一种可接受方法。
尽管血管骨骼化和单独夹闭血管的失血量最高，但仍<总血容量的7.5%。所有5种技术对于体重达26 kg的中小型犬临床使用应是安全的。
