Nylund Adam M, Höglund Odd V, Fransson Boel A
College of Veterinary Medicine, Washington State University, Pullman, Washington.
Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden.
Vet Surg. 2019 May;48(4):563-569. doi: 10.1111/vsu.13109. Epub 2018 Oct 15.
To compare the maximum pressure sustained by airways sealed with a resorbable ligation device (LigaTie) and with thoracoabdominal (TA) staples during thoracoscopic-assisted hilar lung lobectomies.
In situ cadaveric study.
Ten feline cadavers.
Twenty lung lobectomies were performed with either a LigaTie or a TA stapler (n = 10 per group) by using a thoracoscopic-assisted technique. Procedures were randomly performed on the cranial lung lobes only. The distance between the ligation and the hilus was measured on each specimen. Airway pressures were tested to a maximum pressure of 40 cmH O.
All LigaTie sites reached a maximum airway pressure without leaking and were easily placed at the hilus. Four of 10 TA stapled sites leaked at a mean pressure of 22 cmH O (P = .010). All leaks occurred when the TA staple line was >5 mm from the hilus; no leaks occurred when the TA staple line was ≤5 mm from the hilus (P < .001). No difference was found between fresh and frozen cadavers (P = .483) or right vs left lung lobe (P = .284).
Lung lobectomies were consistently performed at the hilus only when the LigaTie was used. Lung lobectomies were less likely to leak when performed with the LigaTie rather compared with TA staples.
The LigaTie may be an effective alternative for lung lobectomies at the pulmonary hilus in cats and small breed dogs. Our findings provide justification for additional clinical testing.
比较在电视胸腔镜辅助肺门肺叶切除术中,使用可吸收结扎装置(LigaTie)和胸腹(TA)吻合器封闭气道时所能承受的最大压力。
原位尸体研究。
10只猫尸体。
采用电视胸腔镜辅助技术,分别使用LigaTie或TA吻合器进行20例肺叶切除术(每组n = 10)。手术仅随机在颅侧肺叶进行。测量每个标本上结扎处与肺门之间的距离。气道压力测试至最大压力40 cmH₂O。
所有LigaTie结扎部位均达到最大气道压力且无漏气,并且易于放置在肺门处。10个TA吻合器吻合部位中有4个在平均压力22 cmH₂O时发生漏气(P = 0.010)。所有漏气均发生在TA吻合线距肺门>5 mm时;当TA吻合线距肺门≤5 mm时未发生漏气(P < 0.001)。新鲜尸体和冷冻尸体之间(P = 0.483)或右肺叶与左肺叶之间(P = 0.284)未发现差异。
仅在使用LigaTie时,肺叶切除术才能始终如一地在肺门处进行。与TA吻合器相比,使用LigaTie进行肺叶切除术时漏气的可能性较小。
LigaTie可能是猫和小型犬肺门处肺叶切除术的有效替代方法。我们的研究结果为进一步的临床试验提供了依据。