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肝手术中用于肝实质横断的德巴基钳压榨技术：100例回顾及人体工程学优势

Debakey forceps crushing technique for hepatic parenchymal transection in liver surgery: a review of 100 cases and ergonomic advantages.

作者信息

Jain Sundeep, Sharma Bharat, Kaushik Mitesh, Jain Lokendra

机构信息

Department of Gastrointestinal Hepatopancreatobiliary Minimal Access & Bariatric Surgery, Fortis Escorts Hospital, Jawahar Lal Nehru Marg, Malviya Nagar, Jaipur, Rajasthan 302017, India.

Department of General & Minimal Access Surgery, Soni Manipal Hospital, Sikar Road, Vidhyadhar Nagar, Jaipur, Rajasthan 302013, India.

出版信息

HPB Surg. 2014;2014:861829. doi: 10.1155/2014/861829. Epub 2014 Jun 9.

DOI:10.1155/2014/861829
PMID:25009367
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4070417/
Abstract

Introduction and Objective. Bleeding is an important complication in liver transections. To determine the safety and efficacy of Debakey forceps for liver parenchymal transection and its ergonomic advantages over clamp crushing method we analysed our data. Methods. We used Debakey crushing technique in 100 liver resections and analysed data for transection time, transfusion rate, morbidity, mortality, hospital stay, influence of different types of liver conditions, and ergonomi features of Debakey forceps. Results. Mean age, transection time and hospital stay of 100 patients were 52.38 ± 17.44 years, 63.36 ± 33.4 minutes, and 10.27 ± 5.7 days. Transection time, and hospital stay in patients with cirrhotic liver (130.4 ± 44.4 mins, 14.6 ± 5.5 days) and cholestatic liver (75.8 ± 19.7 mins, 16.5 ± 5.1 days) were significantly greater than in patients with normal liver (48.1 ± 20.1 mins, 6.7 ± 1.8 days) (P < 0.01). Transection time improved significantly with experience (first fifty versus second fifty cases-70.2 ± 31.1 mins versus 56.5 ± 34.5 mins, P < 0.04). Qualitative evaluation revealed that Debakey forceps had ergonomic advantages over Kelly clamp. Conclusions. Debakey forceps crushing technique is safe and effective for liver parenchymal transection in all kinds of liver. Transection time improves with surgeon's experience. It has ergonomic advantages over Kelly clamp and is a better choice for liver transection.

摘要

引言与目的。出血是肝部分切除术的一项重要并发症。为了确定德巴基钳用于肝实质离断的安全性和有效性及其相对于钳夹压榨法的人体工程学优势，我们分析了我们的数据。方法。我们在100例肝切除术中采用德巴基压榨技术，并分析离断时间、输血率、发病率、死亡率、住院时间、不同类型肝脏疾病的影响以及德巴基钳的人体工程学特征等数据。结果。100例患者的平均年龄、离断时间和住院时间分别为52.38±17.44岁、63.36±33.4分钟和10.27±5.7天。肝硬化肝脏患者（130.4±44.4分钟，14.6±5.5天）和胆汁淤积性肝脏患者（75.8±19.7分钟，16.5±5.1天）的离断时间和住院时间显著长于正常肝脏患者（48.1±20.1分钟，6.7±1.8天）（P<0.01）。随着经验的积累，离断时间显著缩短（前50例与后50例——70.2±31.1分钟与56.5±34.5分钟，P<0.04）。定性评估显示，德巴基钳在人体工程学方面优于凯利钳。结论。德巴基钳压榨技术对于各类肝脏的肝实质离断安全有效。离断时间随着外科医生经验的增加而缩短。它在人体工程学方面优于凯利钳，是肝离断的更好选择。

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本文引用的文献

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Techniques of hepatic resection.肝切除术技术。
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Techniques for liver parenchymal transection in liver resection.肝切除术中肝实质离断技术。
Cochrane Database Syst Rev. 2009 Jan 21;2009(1):CD006880. doi: 10.1002/14651858.CD006880.pub2.
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Meta-analysis of the clamp-crushing technique for transection of the parenchyma in elective hepatic resection: back to where we started?选择性肝切除术中实质离断钳夹压榨技术的Meta分析：回到原点？
Ann Surg Oncol. 2009 Mar;16(3):630-9. doi: 10.1245/s10434-008-0266-7. Epub 2009 Jan 7.
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Usefulness of Kelly clamp crushing technique during hepatic resection.肝切除术中 Kelly 夹压榨技术的应用。
HPB (Oxford). 2008;10(4):281-4. doi: 10.1080/13651820802167144.
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