Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, NC, USA.
HPB (Oxford). 2010 Dec;12(10):703-8. doi: 10.1111/j.1477-2574.2010.00240.x.
The purpose of this study was to evaluate two electrosurgical vessel-sealing devices in biliary surgery.
Porcine common bile ducts (CBDs) were sealed with two electrosurgical devices, an electrothermal bipolar vessel-sealing device (EBVS) and ultrasonic coagulation shears. Acute study animals underwent surgical bile duct sealing followed by immediate burst pressure testing. Chronic study animals were maintained for 1 week postoperatively and then tested.
The seal failure rate in the acute study was 50% for both the EBVS device and shears, and 0% for the laparoscopic surgical clip device used as a control. The latter had significantly higher burst pressures (646.2 ± 281.8 mmHg; P = 0.006) than the EBVS device (97.6 ± 86.6 mmHg) and shears (71.7 ± 89.3 mmHg). No significant difference in burst pressures was noted between the EBVS device and shears (97.6 ± 86.6 mmHg vs. 71.7 ± 89.3 mmHg). In the chronic study, obvious bile leaks occurred in one of four pigs (25%) in the EBVS device subgroup and two of four pigs (50%) in the shears subgroup. The average proximal CBD pressure in seven pigs was 16.1 ± 4.1 mmHg. The average chronic burst pressure in the control subgroup was 1088.0 ± 922.6 mmHg.
Given the high rates of failure of the EBVS device and the shears in consistently sealing biliary ducts, we do not recommend their routine use in biliary surgery.
本研究旨在评估两种电外科血管密封设备在胆道手术中的应用。
采用电热双极血管密封装置（EBVS）和超声凝固剪对猪胆总管（CBD）进行密封。急性研究动物行手术胆管密封后立即进行爆裂压力测试。慢性研究动物术后维持 1 周，然后进行测试。
急性研究中 EBVS 装置和剪刀的密封失败率均为 50%，而作为对照的腹腔镜手术夹装置的失败率为 0%。后者的爆裂压力明显更高（646.2 ± 281.8mmHg；P=0.006），明显高于 EBVS 装置（97.6 ± 86.6mmHg）和剪刀（71.7 ± 89.3mmHg）。EBVS 装置和剪刀的爆裂压力无显著差异（97.6 ± 86.6mmHg 与 71.7 ± 89.3mmHg）。在慢性研究中，EBVS 装置亚组中有 1 只猪（25%）和剪刀亚组中有 2 只猪（50%）出现明显胆汁泄漏。7 只猪的平均近端 CBD 压力为 16.1 ± 4.1mmHg。对照组的平均慢性爆裂压力为 1088.0 ± 922.6mmHg。
鉴于 EBVS 装置和剪刀在一致密封胆管方面的高失败率，我们不建议在胆道手术中常规使用。
