Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15232, USA.
J Thorac Cardiovasc Surg. 2012 Sep;144(3):S48-51. doi: 10.1016/j.jtcvs.2012.06.001.
Energy-based tissue fusion technology is being increasingly used for vascular division in numerous intra-abdominal applications. Very few data, however, are available regarding the application of this technology in the chest during anatomic lung resection. In the present review, we evaluated the use of energy-based fusion and lung sealants during anatomic lung resection.
We performed a review of case series and published studies to evaluate the use of energy-based coagulative fusion technology and lung sealants during anatomic lung resection. We then used energy-based coagulative fusion technology during anatomic lung resection (segmentectomy or lobectomy) in 316 cases from 2008 to 2011. Two energy applications were applied to the arterial and venous branches before vessel division.
In the first 12 cases, we used a device with a small curved jaw (range, 3.3-4.7 mm). Two partial venous dehiscences were noted and controlled intraoperatively. For the remaining cases, we used a larger jaw (6 mm × 22 mm) with no arterial or venous dehiscence occurring (vessels ranged from 0.4 to 1.2 cm). Autologous or synthetic tissue sealants applied to the parenchymal staple lines might reduce the severity and duration of perioperative air leaks. Suture line buttressing with pericardial or absorbable biosynthetic polyester strips might reduce the severity of air leaks in patients with severe emphysema undergoing anatomic lung resection or lung volume reduction surgery.
The bipolar tissue fusion system provides a safe and effective technique for the division of the pulmonary arterial and venous branches during anatomic lung resection. Surgical sealants and buttressing adjuncts might reduce perioperative air leak potential.
基于能量的组织融合技术越来越多地用于许多腹腔内血管分离。然而，在解剖性肺切除术中，关于该技术在胸部应用的数据非常少。在本综述中，我们评估了在解剖性肺切除术中应用能量融合和肺密封剂的情况。
我们对病例系列和已发表的研究进行了回顾，以评估在解剖性肺切除术中应用基于能量的凝固融合技术和肺密封剂的情况。然后，我们在 2008 年至 2011 年间对 316 例解剖性肺切除（肺段切除术或肺叶切除术）患者使用了基于能量的凝固融合技术。在血管分离前，对动脉和静脉分支应用了两种能量。
在前 12 例中，我们使用了一种带有小弯曲钳口（范围为 3.3-4.7 毫米）的设备。术中发现并控制了 2 例静脉部分裂开。对于其余病例，我们使用了一个较大的钳口（6 毫米×22 毫米），没有发生动脉或静脉裂开（血管直径为 0.4 至 1.2 厘米）。应用于实质订书钉线的自体或合成组织密封剂可能会减轻围手术期漏气的严重程度和持续时间。在心包或可吸收生物聚酯条的缝合线支撑下，可能会减轻严重肺气肿患者在解剖性肺切除或肺减容手术中漏气的严重程度。
双极组织融合系统为解剖性肺切除术中肺动静脉分支的分离提供了一种安全有效的技术。手术密封剂和支撑辅助物可能会降低围手术期漏气的可能性。
