Department of Surgery, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
Int J Surg. 2013;11(9):826-33. doi: 10.1016/j.ijsu.2013.08.010. Epub 2013 Aug 28.
In liver surgery different transection techniques are available without clear evidence regarding indication and advantage for each technique. The aim of this study was to identify the most superior liver transection technique between the different techniques (stapler, water-jet and electrocautery). Comparative analyses were performed for minor and major hepatectomies.
In a single-center study, all liver resections performed between July 2007 and July 2012 were prospectively recorded and analysed.
366 liver resections were included according to predefined eligibility criteria. No clear benefit for one particular technique in minor or major hepatectomy could be shown. Cost-effectiveness analysis revealed disadvantages for stapler-hepatectomies. However, minor hepatectomies were performed with significantly lower morbidity (p < 0.001), lower operating time (p = 0.001), fewer need of transfusion (p < 0.0001) and shorter ICU stay (p = 0.001) than major hepatectomies.
If possible, minor hepatectomies should be chosen. Competing techniques, selected according to surgeon's preference, revealed no significant differences in primary outcome measures.
在肝外科手术中，有多种不同的肝离断技术，但是每种技术的适应证和优势尚缺乏明确的证据。本研究旨在比较不同肝离断技术（吻合器、水刀和电刀）之间的优劣。对小肝癌和大肝癌切除术进行了对比分析。
在单中心研究中，前瞻性地记录并分析了 2007 年 7 月至 2012 年 7 月期间进行的所有肝切除术。
根据预设的纳入标准，共有 366 例肝切除术符合纳入标准。小肝癌和大肝癌切除术的特定技术均无明显优势。成本效益分析显示，吻合器肝切除术存在劣势。然而，小肝癌切除术在并发症发生率（p < 0.001）、手术时间（p = 0.001）、输血需求（p < 0.0001）和 ICU 停留时间（p = 0.001）方面均显著低于大肝癌切除术。
如果可能，应选择小肝癌切除术。根据外科医生的偏好选择的竞争性技术在主要结局指标方面没有显著差异。
