Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan.
Surgery. 2013 Nov;154(5):1046-52. doi: 10.1016/j.surg.2013.04.053. Epub 2013 Sep 26.
Excessive intraoperative blood loss and the possible requirement for blood transfusion are major problems in hepatic resection for liver tumors. The decrease of blood loss is a goal in liver surgery, and several technical developments have been introduced for this purpose. The aim of this prospective randomized study was to compare the use of the Cavitron Ultrasonic Surgical Aspirator (CUSA) with a radiofrequency-based bipolar hemostatic sealer versus CUSA with standard bipolar cautery (BC) in patients undergoing hepatic resection.
One hundred nine patients with liver tumors were randomized to undergo hepatic transection via CUSA with a bipolar sealer (Aquamantys 2.3 Bipolar Sealer; n = 55) or BC (n = 54). Blood loss during parenchymal transection and speed of transection were the primary end points, whereas the degree of postoperative liver injury and morbidity were secondary end points.
Compared with the BC group, the bipolar sealer showed lesser blood loss during transection and blood loss divided by resection area (P = .0079 and .0008, respectively), shorter transection time (P = .0025), faster speed of transection (P < .0001), and fewer ties and ties divided by resection area required during transection (P < .0001).
CUSA with a bipolar sealer is superior to CUSA with standard BC for various hepatectomy in terms of less blood loss and faster speed of transection, with no increase in morbidity.
术中出血量过多和可能需要输血是肝肿瘤肝切除的主要问题。减少出血量是肝外科的目标，为此引入了几种技术发展。本前瞻性随机研究的目的是比较超声刀（CUSA）联合射频双极止血夹与 CUSA 联合标准双极电凝用于肝切除术的效果。
109 例肝肿瘤患者随机分为两组，分别采用 CUSA 联合双极止血夹（Aquamantys 2.3 双极止血夹；n = 55）或 CUSA 联合标准双极电凝（n = 54）行肝切除术。术中肝实质离断时的出血量和离断速度为主要终点，而术后肝损伤和并发症的严重程度为次要终点。
与标准双极电凝组相比，双极止血夹组在离断时的出血量和单位切除面积的出血量均较少（P =.0079 和.0008），离断时间较短（P =.0025），离断速度较快（P <.0001），离断过程中所需的结扎数和单位切除面积的结扎数也较少（P <.0001）。
在各种肝切除术中，CUSA 联合双极止血夹在减少出血量和提高离断速度方面优于 CUSA 联合标准双极电凝，且不会增加并发症的发生率。
