Department of Thoracic and Vascular Surgery, SRH Wald-Klinikum Gera, Teaching Hospital of Friedrich-Schiller-University of Jena, Gera, Germany.
J Thorac Cardiovasc Surg. 2013 Jun;145(6):1525-8. doi: 10.1016/j.jtcvs.2012.11.009. Epub 2012 Dec 8.
The LigaSure device has been demonstrated to be safe for systemic vessels up to 7 mm in diameter, although its use in thoracic surgery remains understudied. We aimed to evaluate the safety of LigaSure for pulmonary artery sealing.
In 30 cases of open lung lobectomy, 15 small pulmonary arteries (diameter, 3-5 mm) and 15 thick pulmonary arteries (diameter, 6-8 mm) were divided with LigaSure. Before closure of the thoracotomy, the vessel stumps were ligated proximal to the sealing zone, resected, and preserved in formaldehyde for histopathologic examination. In a control group, a similar number and size of pulmonary arteries were suture-ligated. The burst pressure of the pulmonary arteries from the resected lung lobes was measured.
The mean burst pressure of small pulmonary arteries was 4.3-fold less after sealing than after ligation (315 ± 213.1 mm Hg vs 1345 ± 256 mm Hg; P < .001), and 6.4-fold less than after ligation of thick pulmonary arteries (156 ± 42.5 mm Hg vs 1007 ± 141.6 mm Hg; P < .001). Sealed pulmonary arteries >5 mm in diameter have a burst pressure that is 50% less than that of smaller arteries (P < .001). In all cases after sealing, the histologic examination demonstrated only a fusion of the adventitia, whereas the intima and media were replaced and invaginated into the vessel lumen.
LigaSure does not result in complete fusion of the wall layers of pulmonary arteries. The pulmonary artery burst pressure after sealing is significantly less compared with conventional suture ligation. It remains unclear whether these findings create a clinical risk of rupture.
LigaSure 设备已被证明可安全用于直径达 7 毫米的系统性血管，尽管其在胸外科中的应用仍有待研究。我们旨在评估 LigaSure 用于肺动脉密封的安全性。
在 30 例开胸肺叶切除术中，使用 LigaSure 对 15 条小肺动脉（直径 3-5 毫米）和 15 条厚肺动脉（直径 6-8 毫米）进行了分离。在关闭胸腔之前，将血管残端结扎在密封区域近端，切除并保存在甲醛中以备组织病理学检查。在对照组中，对数量和大小相似的肺动脉进行缝合结扎。测量来自切除肺叶的肺动脉爆裂压力。
小肺动脉密封后的平均爆裂压力比结扎后的低 4.3 倍（315 ± 213.1 毫米汞柱比 1345 ± 256 毫米汞柱；P < 0.001），比结扎厚肺动脉的低 6.4 倍（156 ± 42.5 毫米汞柱比 1007 ± 141.6 毫米汞柱；P < 0.001）。直径大于 5 毫米的密封肺动脉的爆裂压力比较小的动脉低 50%（P < 0.001）。在所有密封后，组织学检查仅显示外膜融合，而内膜和中膜则被替换并向内凹陷进入血管腔。
LigaSure 不会导致肺动脉壁层完全融合。密封后的肺动脉爆裂压力明显低于传统的缝合结扎。目前尚不清楚这些发现是否会导致破裂的临床风险。
