Department of Surgery, Oita Red Cross Hospital, 3-2-37 Chiyomachi, Oita 870-0033, Japan.
Surg Today. 2012 Dec;42(12):1176-82. doi: 10.1007/s00595-012-0306-6. Epub 2012 Sep 20.
This study aimed to evaluate a novel surgical device combination [VIO system containing a bipolar clamp (BiClamp) and the monopolar soft-coagulation (SOFT COAG)] in hepatic resection for patients with hepatocellular carcinoma (HCC).
This study performed 124 hepatic resections for HCC and divided them into 2 groups: 60 patients (Conventional group) underwent liver parenchymal transection using Cavitron Ultrasonic Surgical Aspirator (CUSA) system and saline-coupled bipolar electrocautery for hemostasis; the BiClamp was used with the CUSA system for liver parenchymal transection and SOFT COAG was used with saline-coupled bipolar electrocautery for hemostasis in 64 patients (VIO group).
The median blood loss in the VIO group was 345 mL, which was less than that in the Conventional group (median 548 mL, P = 0.0423). A multivariate logistic regression analysis showed that no use of the VIO system (P = 0.0172) was an independent predictor of intraoperative blood loss, respectively. In patients with liver cirrhosis, the VIO group included a significantly lower proportion of patients with liver cirrhosis that experienced more than 500 mL of intraoperative blood loss in comparison to those in the Conventional group (P = 0.0262).
The VIO system was safe for hepatic resection and its use was associated with a significant decrease in intraoperative blood loss even in cirrhotic patients.
本研究旨在评估一种新的手术设备组合[包含双极钳（BiClamp）和单极软凝（SOFT COAG）的 VIO 系统]在肝细胞癌（HCC）患者肝切除术中的应用效果。
本研究对 124 例 HCC 患者进行了肝切除术，并将其分为 2 组：60 例患者（常规组）采用 Cavitron 超声外科吸引器（CUSA）系统和盐水耦合同步双极电凝进行肝实质离断和止血；64 例患者（VIO 组）采用 CUSA 系统结合 BiClamp 进行肝实质离断，采用盐水耦合同步双极电凝结合 SOFT COAG 进行止血。
VIO 组的中位出血量为 345ml，少于常规组（中位出血量 548ml，P=0.0423）。多变量逻辑回归分析显示，未使用 VIO 系统（P=0.0172）是术中出血量的独立预测因素。在肝硬化患者中，VIO 组中出血量超过 500ml 的患者比例明显低于常规组（P=0.0262）。
VIO 系统在肝切除术中是安全的，即使在肝硬化患者中，也能显著减少术中出血量。
