Kirschbaum Andreas, Rüdell Franziska, Pehl Anika, Bartsch Detlef K
Department of Visceral, Thoracic and Vascular Surgery, Giessen and Marburg University Hospital (UKGM), Marburg, Germany.
Department of Visceral, Thoracic and Vascular Surgery, Giessen and Marburg University Hospital (UKGM), Marburg, Germany.
J Surg Res. 2016 Mar;201(1):202-7. doi: 10.1016/j.jss.2015.09.031. Epub 2015 Oct 14.
Small arteries and veins up to 7 mm can be sealed safe and divided with a bipolar sealing instrument. The results for the safe sealing of larger vessels were unsatisfactory in the past. Using an ex vivo pulmonary artery model, we aimed to investigate, if a higher compression force and duration will improve the bursting pressures in case of vessels >7 mm.
Heart-lung preparations (from 90 kg pigs) were removed en bloc at a slaughterhouse. The whole pulmonary artery was exposed from the pulmonary valve up to the periphery of the left lung. In the laboratory, a digital pressure sensor was implanted in the central end of the blood vessel to measure the bursting pressure (in mbar). The vessels examined were divided into three groups by diameter: 1-6 mm, 7-12 mm and >12 mm. After bipolar sealing, bursting pressures were determined by pneumatic testing. Seals were made using three equal MARSEAL instruments (Gebrüder Martin GmbH & CoKG, Tuttlingen, Germany) with a SealSafe G3 electric current and different jaw compression forces of each 35 N, 45 N, and 55 N. Bursting pressures were also measured for different compression durations (0 s, 5 s, 10 s, and 20 s) with 35 N compression. Mean bursting pressures were calculated for each group (n = 15). Groups were compared using a nonparametric test (Mann-Whitney U test). The significance level was P < 0.05.
Mean bursting pressures in the 1-6 mm blood vessels were 290.5 ± 77.1 mbar (35 N), 323.0 ± 76.0 mbar (45 N) and 301.6 ± 69.9 mbar (55 N). The groups did not differ significantly. Mean bursting pressures in the 7-12 mm vessels were 108.1 ± 19.1 mbar (35 N), 154.3 ± 28.5 mbar (45 N), and 212.4 ± 45.3 mbar (55 N). In blood vessels >12 mm in diameter, we found mean bursting pressures of 77.7 ± 11.7 mbar (35 N), 117.6 ± 27.1 mbar (45 N), and 166.3 ± 56.6 mbar (55 N). The results for the groups with 55 N compression were significantly higher than for the other groups. A compression duration of 5 s led to significantly higher mean bursting pressures than a duration of 0 s but a duration of >5 s did not bring a further significant increase in mean bursting pressure. Histologic staining of the seal zone and microscopic examination did not reveal any differences relating to compression force.
With a higher compression force, we reached satisfactory bursting pressures in case of pulmonary arteries >7 mm. An additional 5 s of compression before starting coagulation brings a further significant increase in bursting pressure. However, there is no advantage in a longer compression.
直径达7毫米的小动脉和小静脉可用双极密封器械安全地进行密封和切断。过去，对较大血管进行安全密封的效果并不理想。我们利用一个离体肺动脉模型，旨在研究对于直径大于7毫米的血管，更高的压缩力和持续时间是否会提高破裂压力。
在屠宰场将心肺标本（取自90千克的猪）整体取出。将整个肺动脉从肺动脉瓣一直暴露到左肺周边。在实验室中，将一个数字压力传感器植入血管的中央端以测量破裂压力（以毫巴为单位）。所检查的血管按直径分为三组：1 - 6毫米、7 - 12毫米和大于12毫米。双极密封后，通过气动测试确定破裂压力。使用三台相同的MARSEAL器械（德国图特林根的Gebrüder Martin GmbH & CoKG公司），设置SealSafe G3电流以及每台器械不同的钳口压缩力，分别为35牛、45牛和55牛来进行密封。还测量了在35牛压缩力下不同压缩持续时间（0秒、5秒、10秒和20秒）时的破裂压力。计算每组（n = 15）的平均破裂压力。使用非参数检验（曼 - 惠特尼U检验）对各组进行比较。显著性水平为P < 0.05。
1 - 6毫米血管的平均破裂压力分别为290.5 ± 77.1毫巴（35牛）、323.0 ± 76.0毫巴（45牛）和301.6 ± 69.9毫巴（55牛）。各组之间无显著差异。7 - 12毫米血管的平均破裂压力分别为108.1 ± 19.1毫巴（35牛）、154.3 ± 28.5毫巴（45牛）和212.4 ± 45.3毫巴（55牛）。在直径大于12毫米的血管中，我们发现平均破裂压力分别为77.7 ± 11.7毫巴（35牛）、117.6 ± 27.1毫巴（45牛）和166.3 ± 56.6毫巴（55牛）。55牛压缩力组的结果显著高于其他组。5秒的压缩持续时间导致平均破裂压力显著高于0秒，但大于5秒的持续时间并未使平均破裂压力进一步显著增加。密封区域的组织学染色和显微镜检查未发现与压缩力相关的任何差异。
对于直径大于7毫米的肺动脉，通过更高的压缩力，我们获得了令人满意的破裂压力。在开始凝血前额外压缩5秒会使破裂压力进一步显著增加。然而，更长时间的压缩并无优势。
