Yao Dian-Bo, Wu Shuo-Dong
Dian-Bo Yao, Shuo-Dong Wu, Second Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China.
World J Gastroenterol. 2016 Aug 21;22(31):7091-8. doi: 10.3748/wjg.v22.i31.7091.
The liver is a vascular-rich solid organ. Safe and effective dissection of the vessels and liver parenchyma, and control of intraoperative bleeding are the main concerns when performing liver resection. Several studies have confirmed that intraoperative blood loss and postoperative transfusion are predictors of postoperative morbidity and mortality in liver surgery. Various methods and instruments have been developed during hepatectomy. Stapling devices are crucial for safe and rapid anastomosis. They are used to divide hepatic veins and portal branches, and to transect liver parenchyma in open liver resection. In recent years, laparoscopic liver surgery has developed rapidly, and is now preferred by many surgeons. Stapling devices have also been gradually introduced in laparoscopic liver surgery, from dividing vascular and biliary structures to parenchymal transection. This may be because staplers make manipulation more simple, rapid and safe. Even in single incision laparoscopic surgery, which is recognized as a new minimally invasive technique, staplers are also utilized, especially in left lateral hepatectomy. For safe application of stapling devices in liver surgery, more related designs and modifications, such as application of a suitable laparoscopic articulating liver tissue crushing device, a staple line reinforcement technique with the absorbable polymer membrane or radiofrequency ablation assistance, are still needed. More randomized studies are needed to demonstrate the benefits and find broader indications for the use of stapling devices, to help expand their application in liver surgery.
肝脏是一个血管丰富的实体器官。在进行肝切除时，安全有效地解剖血管和肝实质以及控制术中出血是主要关注点。多项研究证实，术中失血和术后输血是肝手术术后发病率和死亡率的预测因素。在肝切除术中已开发出各种方法和器械。吻合器对于安全快速的吻合至关重要。它们用于在开放肝切除术中分割肝静脉和门静脉分支以及横断肝实质。近年来，腹腔镜肝手术发展迅速，现在受到许多外科医生的青睐。吻合器也已逐渐引入腹腔镜肝手术中，从分割血管和胆管结构到实质横断。这可能是因为吻合器使操作更简单、快速且安全。即使在被认为是一种新型微创技术的单切口腹腔镜手术中，也会使用吻合器，尤其是在左外叶肝切除术中。为了在肝手术中安全应用吻合器，仍需要更多相关的设计和改进，例如应用合适的腹腔镜关节式肝组织粉碎装置、使用可吸收聚合物膜的钉合线加固技术或射频消融辅助技术。需要更多的随机研究来证明使用吻合器的益处并找到更广泛的适应证，以帮助扩大其在肝手术中的应用。
