Kirschbaum Andreas, Kunz Julia, Steinfeldt Thorsten, Pehl Anika, Meyer Christian, Bartsch Detlef K
Department of Visceral, Thoracic and Vascular Surgery, Philipps-University Marburg, Marburg, Germany.
Department of Visceral, Thoracic and Vascular Surgery, Philipps-University Marburg, Marburg, Germany.
J Surg Res. 2014 Dec;192(2):611-5. doi: 10.1016/j.jss.2014.07.014. Epub 2014 Jul 15.
In every anatomic lung resection operation, the pulmonary artery itself or its branches must be sealed. This involves either stapling or ligating the vessels. Based on the positive results with the bipolar vessel sealing ≤7 mm in abdominal surgery the present study aimed to evaluate burst pressures of the pulmonary artery after sealing with the sealing instrument SealSafe G3 (Gebrüder Martin & CoKG, Tuttlingen, Germany).
The whole pulmonary artery above the pulmonary valve was exposed up to the periphery of the left lung in freshly removed pig heart-lung blocks. A pressure-measuring cylinder was then implanted in the prepared vessel on the side at the main trunk of the pulmonary artery to determine the pressure in the vessel. After either ligation or bipolar sealing of the pulmonary artery, the pneumatic burst pressure (millimeters of mercury) was determined in a water bath. Three groups (n = 12 for each seal type) with different vessel diameters were examined: group 1: 0-6 mm, group 2: 7-12 mm, and group 3: >12 mm. In all cases, vessel sealing was performed with a MARSEAL 5 instrument (Gebrüder Martin & Co KG, Tuttlingen, Germany) and the SealSafe G3 current. The mean burst pressures of the individual groups (ligature and bipolar sealing) were compared using two-tailed, nonparametric Mann-Whitney U test. Significance was defined as P < 0.05.
The mean burst pressures in group 1 were measured by 340 ± 13.4 mm Hg with ligature and 205 ± 44.4 mm Hg with bipolar sealing (P < 0.001). In group 2, the mean values obtained were 270 ± 28.2 mm Hg for ligature and 162 ± 36.0 mm Hg for bipolar sealing (P < 0.001). In group 3, the mean burst pressures for bipolar sealing were only 52.1 ± 15.1 mm Hg, whereas those for ligated vessels were 253 ± 46.9 mm Hg (P < 0.001). For this size of vessel the burst pressure was also determined after stapling. The mean value in this case was 230 ± 21.8 mm Hg.
In all groups, the mean burst pressures after bipolar sealing were significantly lower than those achieved with ligation, but they were sufficient for a save closure of the pulmonary artery with diameters up to 12 mm.
在每一台肺切除手术中，肺动脉本身或其分支都必须进行封闭。这涉及到用吻合器缝合或结扎血管。基于双极血管封闭器在腹部手术中对直径≤7毫米血管封闭的良好效果，本研究旨在评估使用SealSafe G3封闭器（德国图特林根的格布勒·马丁两合公司）封闭肺动脉后的破裂压力。
在新鲜取出的猪心肺块中，暴露肺动脉瓣上方直至左肺周边的整个肺动脉。然后在肺动脉主干一侧准备好的血管中植入一个压力测量筒，以测定血管内压力。在结扎或双极封闭肺动脉后，在水浴中测定气动破裂压力（毫米汞柱）。检查了三组不同血管直径的样本（每种封闭类型n = 12）：第1组：0 - 6毫米，第2组：7 - 12毫米，第3组：>12毫米。在所有情况下，使用MARSEAL 5器械（德国图特林根的格布勒·马丁两合公司）和SealSafe G3电流进行血管封闭。使用双尾非参数曼 - 惠特尼U检验比较各小组（结扎和双极封闭）的平均破裂压力。显著性定义为P < 0.05。
第1组中，结扎后的平均破裂压力为340 ± 13.4毫米汞柱，双极封闭后的为205 ± 44.4毫米汞柱（P < 0.001）。在第2组中，结扎的平均值为270 ± 28.2毫米汞柱，双极封闭的为162 ± 36.0毫米汞柱（P < 0.001）。在第3组中，双极封闭的平均破裂压力仅为52.1 ± 15.1毫米汞柱，而结扎血管的为253 ± 46.9毫米汞柱（P < 0.001）。对于这种尺寸的血管，在使用吻合器缝合后也测定了破裂压力。在这种情况下的平均值为230 ± 21.8毫米汞柱。
在所有组中，双极封闭后的平均破裂压力显著低于结扎后的压力，但对于直径达12毫米的肺动脉，这些压力足以实现安全封闭。
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