Department of Surgery, University of Catania A.O.U. "Policlinico - Vittorio Emanuele", Catania, Italy.
Eur Rev Med Pharmacol Sci. 2014 Dec;18(2 Suppl):54-9.
Nowadays, laparoscopic cholecystectomy (LC) is undoubtedly considered the "gold standard" in the surgical treatment of symptomatic gallstones, gallbladder adenomas and acute cholecystitis. Among the alternative energy sources proposed (monopolar, bipolar electric scalpel, radiofrequency sealers) with the aim to dissect and/or seal, the ultrasonic energy has been frequently adopted, however without a widespread acceptance among surgeons for routine or emergency laparoscopic cholecystectomy. This study investigates the possible beneficial aspects of ultrasonic dissection and its efficacy in the closure of the cystic artery and duct.
Patients were retrospectively divided into 2 groups according to the instruments used for division of the cystic artery and duct as well as for dissection of the liver bed: 121 patients in whom dissection and coagulation were performed using monopolar coagulation and 43 patients who were all treated with the ultrasonically activated scalpel harmonic ACE (Ethicon Endo-Surgery) as the sole instrument used in the whole procedure.
The mean operative time, was significantly shorter in the harmonic group than in the traditional group (35.36 + 10.15 min vs. 55.6+12.10 vs. respectively; p < 0.0001). The rate of gallbladder perforation was significantly higher in the traditional group than in the harmonic group 20.66% (25 patients) vs. 6.98% (3 patients), respectively; p < 0.05). Intraoperative volume blood loss was significantly more in the traditional group than in the HS group (29.32+14.21 vs. 12.41+8.22; p < 0.0001). The mean amount of postoperative drainage was not significantly different among the two group (18.41+6.54 vs. 15.96+8.69 ml, p > 0.05). No considerable visceral injury has been recorded in either group. The postoperative parameters observed included postoperative hospital stay and morbidity for each group. The hospital stay was not significantly shorter in harmonic group (48.15+4.29 vs. 49.06+2.94 h, p > 0.05). The overall morbidity rate was 14.02 % (not significant).
The use of the harmonic scalpel shows some statistically significant advantages limited to a few intraoperative parameters. We conclude that a wider use of harmonic scalpel not offers such advantages to make it the reference technique.
如今，腹腔镜胆囊切除术（LC）无疑被认为是治疗有症状的胆囊结石、胆囊腺瘤和急性胆囊炎的“金标准”。在提出的替代能源（单极、双极电刀、射频密封器）中，有用于解剖和/或密封的超声能量，但由于其在常规或紧急腹腔镜胆囊切除术中的接受程度不高，因此并未得到广泛应用。本研究旨在探讨超声解剖的可能有益方面及其在胆囊动脉和胆管闭合中的效果。
根据用于分离胆囊动脉和胆管以及肝床解剖的仪器，将患者回顾性地分为 2 组：121 例患者使用单极电凝进行解剖和凝血，43 例患者使用超声激活刀 harmonic ACE（Ethicon Endo-Surgery）作为整个手术过程中唯一使用的仪器进行治疗。
超声组的平均手术时间明显短于传统组（35.36+10.15 分钟比 55.6+12.10 分钟，p<0.0001）。传统组胆囊穿孔的发生率明显高于超声组（20.66%（25 例）比 6.98%（3 例），p<0.05）。传统组术中出血量明显多于 HS 组（29.32+14.21 比 12.41+8.22，p<0.0001）。两组术后引流量无显著差异（18.41+6.54 比 15.96+8.69ml，p>0.05）。两组均无明显内脏损伤。观察的术后参数包括每组的术后住院时间和发病率。超声组的住院时间没有明显缩短（48.15+4.29 比 49.06+2.94 小时，p>0.05）。总发病率为 14.02%（无显著差异）。
超声刀的使用在少数术中参数上显示出一些具有统计学意义的优势。我们得出的结论是，超声刀的更广泛应用并没有带来这样的优势，使其成为参考技术。
