Institut de chirurgie expérimentale, CRLCC Léon Bérard, Lyon, France.
Ann Surg Oncol. 2012 Jul;19 Suppl 3:S447-54. doi: 10.1245/s10434-011-1875-0. Epub 2011 Jul 28.
Bleeding is the main cause of postoperative complications of hepatic surgery. To minimize intraoperative bleeding during hepatectomy, resections are generally carried out under hepatic vascular control despite the risk of liver dysfunction in patients with chronic liver disease. This study evaluates the feasibility and safety of high-intensity focused ultrasound (HIFU)-assisted hepatic resection during an open procedure in an animal model.
Three groups of 12-14-week-old Landrace pigs (n = 7/group) were used to evaluate HIFU-assisted liver resection (group A) vs liver resection with or without portal triad clamping (groups B and C). In each pig, liver resection was performed on the right and left paramedian lobes. The following were evaluated and compared in the 3 groups: total blood loss, blood loss/cm(2) of resection area, clip density, procedure duration, morbidity, and mortality.
Median blood loss was significantly lower in group A than in group B (P = .02), and group C (P = .007). Median blood loss/cm(2) of resection area was 4.77 mL/cm² in group A, 11.35 mL/cm² in group B, 12.22 mL/cm² in Group C. Precoagulation resulted in sealing blood vessels <5 mm; therefore, median clip density during liver transection was 0.78 clip/cm² in group A, 1.61 clip/cm(2) in group B, and 1.57 clip/cm(2) in group C. Median duration of the surgical procedure was 12 min in group A, 21 min in group B, and 19 min in group C.
HIFU-assisted hepatic resection during an open procedure in an animal model is safe, reduces bleeding, and allows real-time ultrasound guidance.
出血是肝外科术后并发症的主要原因。为了最大限度地减少肝切除术中的出血，尽管慢性肝病患者存在肝功能障碍的风险，但通常在肝血管控制下进行肝切除术。本研究评估了高强度聚焦超声（HIFU）辅助下在动物模型中进行开放性肝切除术的可行性和安全性。
使用三组 12-14 周龄长白猪（每组 n = 7）评估 HIFU 辅助肝切除（A 组）与肝切除伴或不伴门脉三联夹闭（B 组和 C 组）。在每头猪中，均在右和左旁正中叶进行肝切除术。在 3 组中评估和比较以下内容：总出血量、切除区域每平方厘米出血量、夹密度、手术时间、发病率和死亡率。
A 组的中位出血量明显低于 B 组（P =.02）和 C 组（P =.007）。A 组切除区域每平方厘米的中位出血量为 4.77 毫升/平方厘米，B 组为 11.35 毫升/平方厘米，C 组为 12.22 毫升/平方厘米。预凝导致 <5 毫米的血管封闭；因此，A 组肝切断术中的中位夹密度为 0.78 夹/平方厘米，B 组为 1.61 夹/平方厘米，C 组为 1.57 夹/平方厘米。A 组手术时间的中位数为 12 分钟，B 组为 21 分钟，C 组为 19 分钟。
在动物模型中进行的开放性手术中，HIFU 辅助肝切除安全、减少出血，并允许实时超声引导。
