Kirschbaum A, Sasse T, Palade E
Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Deutschland.
Zentralbl Chir. 2014 Jun;139(3):342-5. doi: 10.1055/s-0033-1350858. Epub 2014 Jan 7.
In every pneumonectomy due to a malignant or benign pulmonary disease the pulmonary artery must be centrally ligated and dissected. If a thoracotomy is undertaken the vessel is usually doubly ligated with a non-absorbable suture and then dissected. Alternatively a vessel stapler can be used. In a thorascopic procedure only the stapler can be used. In the search for a cheaper alternative we investigated whether a bipolar instrument as employed in thorascopy could be used and reused. The aim of this study was to investigate the static pressure performance of the closed vessel in an ex vivo non-perfused vessel model.
From freshly slaughtered pigs the heart-lung block was removed. The central pulmonary artery was exposed. For sealing the vessel we used the bipolar sealing system MARSEAL®, Brothers Martin company (Tuttlingen, Germany), consisting of an HF generator and a MARSEAL slim instrument. Two groups were formed: group A (n = 49) Stromart SealSafe®, step G5 (automatic performance regulation, duration of use depending on impedance) and group B (n = 58) bipolar Stromart "Macrocoag" (power: 120 W, constant duration of use: 15 s). At the end of the pulmonary artery a pressure probe was implanted to digitally measure the pressure at the vessel sealing suture. After sealing the end of the artery, the vessel was slowly filled via an external source in order to determine the burst pressure. The burst pressure was reached as soon as the vessel suture started to leak. The average values of the 2 groups were then compared (t test for independent variables, significance set at p < 0.05).
All examined vessels (n = 107) had the same vessel diameter of 15 ± 3 mm. The average value of the burst pressure in group A was 139.3 ± 62.17 mmHg, that in group B 124.8 ± 38.46 mmHg. The ranges of burst pressures were in group A 51-297.0 mmHg und in group B 60.75-244.5 mmHg. There was no significant difference between group A and group B (p = 0.071).
Satisfactory burst pressures in the central pulmonary artery can also be achieved with the bipolar sealing instrument MARSEAL® and the impedance-controlled Stromart SealSafe®. However, because of the large scattering of the measured values, further studies are required.
在因恶性或良性肺部疾病进行的每例肺切除术中，肺动脉都必须在中心进行结扎和解剖。如果进行开胸手术，该血管通常用不可吸收缝线双重结扎，然后进行解剖。或者也可以使用血管吻合器。在胸腔镜手术中则只能使用吻合器。为了寻找更便宜的替代方法，我们研究了胸腔镜中使用的双极器械是否可以使用和重复使用。本研究的目的是在离体非灌注血管模型中研究闭合血管的静压性能。
从刚屠宰的猪身上取出心肺块。暴露中心肺动脉。为了封闭血管，我们使用了德国图特林根的马丁兄弟公司生产的双极密封系统MARSEAL®，它由高频发生器和MARSEAL纤细器械组成。分为两组：A组（n = 49），Stromart SealSafe®，G5级（自动性能调节，使用持续时间取决于阻抗）；B组（n = 58），双极Stromart “Macrocoag”（功率：120 W，固定使用持续时间：15秒）。在肺动脉末端植入压力探头以数字方式测量血管封闭缝线处的压力。封闭动脉末端后，通过外部源缓慢填充血管以确定破裂压力。一旦血管缝线开始渗漏，就达到了破裂压力。然后比较两组的平均值（独立变量的t检验，显著性设定为p < 0.05）。
所有检查的血管（n = 107）直径均为15 ± 3 mm。A组破裂压力的平均值为139.3 ± 62.17 mmHg，B组为124.8 ± 38.46 mmHg。A组破裂压力范围为51 - 297.0 mmHg，B组为60.75 - 244.5 mmHg。A组和B组之间无显著差异（p = 0.071）。
使用双极密封器械MARSEAL®和阻抗控制的Stromart SealSafe®也可以在中心肺动脉中获得令人满意的破裂压力。然而，由于测量值的较大离散性，还需要进一步研究。
