Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
HPB (Oxford). 2011 Jun;13(6):431-7. doi: 10.1111/j.1477-2574.2011.00314.x. Epub 2011 May 5.
To evaluate any change in the operative and survival outcomes in patients undergoing a right hepatectomy after adoption of the no-clamp technique using a radiofrequency dissecting sealer (TissueLink™) in liver resection.
In all, 58 consecutive patients who underwent a right hepatectomy from July 2003 to December 2007 (Group 1) were compared with 66 consecutive patients who underwent a right hepatectomy from January 1999 to June 2003 (Group 2). In group 1, a liver transection was performed with a cavitron ultrasonic surgical aspirator (CUSA) and TissueLink™ without hilar clamping whereas in group 2, a liver transection was performed with CUSA and diathermy with routine continuous hilar clamping.
For the operative outcomes, there was significantly less blood loss (median 450 vs. 900 ml, P < 0.001) in group 1. The complication rate was also significantly lower in group 1 (22.4% vs. 47.0%, P = 0.004). In subgroup analysis for patients with hepatocellular carcinoma (HCC), the overall survival rate was significantly better in group 1; 1-, 3- and 5-year survival rates were 78%, 72% and 57% in group 1 vs. 72%, 44% and 39% in group 2, respectively (P = 0.048).
When compared with the retrospective cohort, a right hepatectomy utilizing TissueLink™ without hilar clamping was feasible with potential benefits in surgical outcomes.
评估在肝切除中使用射频解剖密封器（TissueLink™）无夹闭技术行右半肝切除术的手术和生存结果的任何变化。
总共比较了 58 例连续接受右半肝切除术的患者，这些患者分别于 2003 年 7 月至 2007 年 12 月（组 1）和 1999 年 1 月至 2003 年 6 月（组 2）连续接受右半肝切除术。在组 1 中，使用 Cavitron 超声外科吸引器（CUSA）和 TissueLink™ 进行肝实质离断，而不进行肝门阻断，而在组 2 中，使用 CUSA 和常规连续肝门阻断进行电凝进行肝实质离断。
在手术结果方面，组 1 的术中出血量明显减少（中位数为 450ml 比 900ml，P <0.001）。组 1 的并发症发生率也明显较低（22.4%比 47.0%，P = 0.004）。在肝细胞癌（HCC）患者的亚组分析中，组 1 的总生存率明显更好；组 1 的 1 年、3 年和 5 年生存率分别为 78%、72%和 57%，组 2 分别为 72%、44%和 39%（P = 0.048）。
与回顾性队列相比，使用 TissueLink™ 无肝门阻断的右半肝切除术是可行的，并且在手术结果方面具有潜在的益处。
