Department of Surgery, University of Arizona Health Science Center, Tucson, AZ, USA.
Ann Surg Oncol. 2014 Mar;21(3):995-1001. doi: 10.1245/s10434-013-3331-9. Epub 2013 Nov 19.
Transection of liver parenchyma using staplers is now commonly performed. Large studies are needed to assess the usefulness of the technique as well as perioperative outcomes.
This is a retrospective study of a prospectively maintained database. A total of 1,174 patients undergoing liver resections in routine surgical practice, using a stapler device at MD Anderson Cancer Center between January 1, 1994 and November 10, 2011 were evaluated.
There were 900 major resections (3 segments or more) (77 %) and 274 minor resections (<3 segments or wedge resections) (23 %). A vast majority, 1,133 (96.5 %), were indicated for an underlying malignancy (24 % primary liver or gall bladder and 72.5 % metastatic) compared with benign disease, 41 (3.5 %), with the most common indication being metastatic colorectal cancer 584 (49.7 %). Of the total 1,174 patients 128 (10.9 %) had a prior liver resection. Median OR time and blood loss was 206 min and 300 mL, respectively, with 11 % of patients requiring transfusion in the perioperative or postoperative period. Overall morbidity and mortality rate was 14 and 3.2 %, respectively, with a median hospital stay of 7 days (interquartile range [IQR], 4 days). Multivariate logistic regression demonstrated blood loss and extent of liver resection to be independent predictors of adverse outcome. A total of 13 instances (1.1 %) of misfired staplers were noted and were associated with higher blood loss (p < 0.001) and mortality (15 vs. 3.1 %, p = 0.013).
Use of stapler device for hepatic resection is safe and effective, but rare instances of a misfired stapler device are associated with an adverse outcome.
目前，使用吻合器横断肝脏实质已较为常见。需要开展大型研究来评估该技术的实用性及其围手术期结果。
这是一项对前瞻性维护的数据库进行的回顾性研究。评估了 1994 年 1 月 1 日至 2011 年 11 月 10 日期间，在 MD 安德森癌症中心常规外科手术中使用吻合器装置进行肝脏切除术的 1174 例患者。
900 例为大切除术（3 个节段或更多）（77%），274 例为小切除术（<3 个节段或楔形切除术）（23%）。绝大多数患者（96.5%）存在潜在恶性肿瘤（24%为原发性肝或胆囊癌，72.5%为转移性肿瘤），41 例（3.5%）为良性疾病，最常见的原因为转移性结直肠癌，共 584 例（49.7%）。1174 例患者中，128 例（10.9%）有既往肝脏切除术。手术时间和术中出血量的中位数分别为 206 分钟和 300 毫升，11%的患者在围手术期或术后需要输血。总的发病率和死亡率分别为 14%和 3.2%，中位住院时间为 7 天（四分位距 [IQR]，4 天）。多变量逻辑回归显示，术中出血量和肝脏切除范围是不良预后的独立预测因素。总共发现 13 例（1.1%）吻合器故障，其出血量（p < 0.001）和死亡率（15%与 3.1%，p = 0.013）均更高。
使用吻合器装置进行肝切除术是安全有效的，但吻合器装置偶尔出现故障会导致不良预后。
