Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
J Thorac Cardiovasc Surg. 2019 Jan;157(1):388-395. doi: 10.1016/j.jtcvs.2018.02.113. Epub 2018 Apr 30.
Vascular sealing with an energy vessel sealing system during lung resection may allow surgeons to treat small vessels with minimal dissection, possibly decreasing likelihood of injury. Few large prospective trials have examined the proximal sides of vessels not ligated in addition to sealing during surgery. We therefore assessed feasibility of an energy device to seal pulmonary artery and vein branches without further ligation.
This prospective, preoperative registration study at 2 institutions evaluated safety of energy sealing with the LigaSure (Medtronic, Minneapolis, Minn), with no additional reinforcing material such as suture ligation, for pulmonary vessels as large as 7 mm during anatomic lung resection (cohort 1 study). A postoperative hemorrhage occurred in the 128th case, so a cohort 2 study proceeded after we changed inclusion criterion for pulmonary arteries from a maximum of 7 mm to a maximum of 5 mm.
In cohort 1 (n = 128) and cohort 2 (n = 200), 216 and 250 pulmonary arteries and 189 and 213 pulmonary veins, respectively, were treated with energy sealing. Overall postoperative hemorrhage rate was 0.3% (1/328 patients); however, no serious postoperative complications were associated with energy sealing among the 200 patients in cohort 2. Subsequent inspection of the torn artery stump confirmed that the bleeding in the 128th case was in an area adjacent to the sealing zone.
Energy sealing without reinforcement allows secure treatment during lung resection of pulmonary arteries as large as 5 mm in diameter and pulmonary veins as large as 7 mm.
在肺切除术中使用能量血管密封系统进行血管密封，可能使外科医生能够最小限度地进行血管解剖，从而降低损伤的可能性。很少有大型前瞻性试验除了在手术中密封外，还检查了未结扎的血管的近端。因此，我们评估了能量装置是否能够安全地密封肺动脉和静脉分支，而无需进一步结扎。
这项前瞻性、术前登记研究在 2 家机构中进行，评估了 LigaSure（美敦力，明尼苏达州明尼阿波利斯市）能量密封的安全性，即在解剖性肺切除术中，对于最大直径为 7mm 的肺血管，无需额外的加固材料，如缝线结扎（队列 1 研究）。在第 128 例患者中发生了术后出血，因此在我们将肺动脉的纳入标准从最大 7mm 更改为最大 5mm 后，进行了队列 2 研究。
在队列 1（n=128）和队列 2（n=200）中，分别对 216 条和 250 条肺动脉以及 189 条和 213 条肺静脉进行了能量密封。总的术后出血率为 0.3%（328 例患者中有 1 例）；然而，在队列 2 的 200 例患者中，没有与能量密封相关的严重术后并发症。对撕裂的动脉残端的后续检查证实，第 128 例患者的出血发生在密封区域附近。
无需加固的能量密封可在最大直径为 5mm 的肺动脉和最大直径为 7mm 的肺静脉的肺切除术中安全治疗。
