Pogorelić Zenon, Katić Josip, Mrklić Ivana, Jerončić Ana, Šušnjar Tomislav, Jukić Miro, Vilović Katarina, Perko Zdravko
Department of Pediatric Surgery, University Hospital of Split, Split, Croatia; School of Medicine, University of Split, Split, Croatia.
School of Medicine, University of Split, Split, Croatia.
J Surg Res. 2017 May 15;212:101-107. doi: 10.1016/j.jss.2017.01.014. Epub 2017 Jan 28.
The aim of this study was to compare lateral thermal damage of mesoappendix and appendiceal base using three different instruments for sealing and cutting of mesoappendix.
A total number of 99 patients (54 males and 45 females) who underwent laparoscopic appendectomy because of suspected appendicitis between December 2013 and May 2015 were enrolled in the study. The patients were divided in three groups based on instrument used for sealing of mesoappendix: group 1 (Ultracision; n = 36), group 2 (LigaSure; n = 32), and group 3 (MiSeal; n = 31). Lateral thermal damage, intraoperative and postoperative complications, duration of surgery, hospital stay, and economic value were compared within groups.
The median age of patients was 14 y (range 3-17). A histopathologic analysis revealed a positive diagnosis of appendicitis in 84 patients (85%). The median lateral thermal damage on appendiceal base using Ultracision, LigaSure, and MiSeal was 0.10 mm, 0.16 mm, and 0.10 mm respectively, and on mesoappendix, 0.08 mm, 0.13 mm, and 0.08 mm, respectively. Significantly higher thermal damage was found on mesoappendix (P = 0.015) and appendiceal base (P = 0.012) in patients treated with LigaSure than in patients from other groups. There were no statistical differences among the groups regarding intraoperative and postoperative complications (P = 0.098). No significant difference in thermal damage between appendicitis and nonappendicitis group was found (P = 0.266).
Using of Ultracision, LigaSure, and MiSeal for sealing of mesoappendix in laparoscopic appendectomy in children is safe and useful. LigaSure produces significantly greater lateral thermal damage compared with other instruments.
本研究旨在比较使用三种不同器械封闭和切断阑尾系膜时阑尾系膜和阑尾根部的侧向热损伤情况。
选取2013年12月至2015年5月间因疑似阑尾炎行腹腔镜阑尾切除术的99例患者（54例男性，45例女性）纳入研究。根据用于封闭阑尾系膜的器械将患者分为三组：第1组（超声刀；n = 36），第2组（结扎速血管闭合系统；n = 32），第3组（MiSeal；n = 31）。比较各组的侧向热损伤、术中及术后并发症、手术时间、住院时间和经济价值。
患者的中位年龄为14岁（范围3 - 17岁）。组织病理学分析显示84例患者（85%）阑尾炎症诊断阳性。使用超声刀、结扎速血管闭合系统和MiSeal时，阑尾根部的中位侧向热损伤分别为0.10毫米、0.16毫米和0.10毫米，阑尾系膜的中位侧向热损伤分别为0.08毫米、0.13毫米和0.08毫米。使用结扎速血管闭合系统治疗的患者，阑尾系膜（P = 0.015）和阑尾根部（P = 0.012）的热损伤明显高于其他组患者。各组间术中及术后并发症无统计学差异（P = 0.098）。阑尾炎组和非阑尾炎组的热损伤无显著差异（P = 0.266）。
在儿童腹腔镜阑尾切除术中使用超声刀、结扎速血管闭合系统和MiSeal封闭阑尾系膜是安全有效的。与其他器械相比，结扎速血管闭合系统产生的侧向热损伤明显更大。
