Aoki Takeshi, Murakami Masahiko, Koizumi Tomotake, Enami Yuta, Koike Reiko, Fujimori Akira, Kusano Tomokazu, Matsuda Kazuhiro, Yamada Kosuke, Nogaki Koji, Watanabe Makoto, Otsuka Koji, Gareer Haytham, Kato Takashi
Department of Gastroenterological & General Surgery, School of Medicine, Showa University, Tokyo, Japan.
Int Surg. 2015 Jun;100(6):1048-53. doi: 10.9738/INTSURG-D-14-00258.1.
This study describes a novel technique for skeletonization and isolation of Glissonean and venous branches during liver surgery using a harmonic scalpel (HS). Hepatic resections with HS were performed with the skeletonization and isolation technique in 50 patients (HS group). Variables evaluated were blood loss, operative time, biliary leak, and morbidity. The results were compared with 50 hepatic resections that were performed using a previously established technique: Cavitron ultrasonic surgical aspirator with electric cautery, ligatures, and hemoclips (NHS group). The HS group had shorter total operative times (285 versus 358 minutes; P = 0.01), less blood loss (389 versus 871 mL; P = 0.034), and less crystalloid infusion (2744 versus 3299 mL; P = 0.027) compared with the NHS group. Postoperative liver function and complication rates were similar when comparing the two groups. These data demonstrate that HS is a simple, easy, and effective instrument for the skeletonization and isolation of vessels during liver transection.
本研究描述了一种在肝脏手术中使用超声刀（HS）对肝门部血管和静脉分支进行骨骼化处理及分离的新技术。对50例患者采用超声刀进行肝脏切除，并运用骨骼化处理及分离技术（超声刀组）。评估的变量包括失血量、手术时间、胆漏及发病率。将结果与50例采用先前既定技术进行肝脏切除的患者进行比较：使用超声外科吸引器联合电灼、结扎和血管夹（传统组）。与传统组相比，超声刀组的总手术时间更短（285分钟对358分钟；P = 0.01），失血量更少（389毫升对871毫升；P = 0.034），晶体液输注量更少（2744毫升对3299毫升；P = 0.027）。两组比较时，术后肝功能和并发症发生率相似。这些数据表明，超声刀是肝脏横断术中用于血管骨骼化处理及分离的一种简单、易用且有效的器械。
