Shimizu Nahoko, Tanaka Yugo, Okamoto Takeshi, Doi Takefumi, Hokka Daisuke, Maniwa Yoshimasa
Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
J Thorac Dis. 2018 Dec;10(12):6466-6471. doi: 10.21037/jtd.2018.11.14.
Advances in the development of staplers for pulmonary vessels have contributed to safe and convenient procedures in thoracic surgery. However, adverse events (AEs) can occur during vascular stapling and cause fatal hemorrhage. We aimed to assess the risk level of using the vessel stapling procedure to reduce such AEs.
First, an animal experiment using pig cardiopulmonary blocks was conducted. Pulmonary arteries were closed with staplers under stressful conditions such as lifting or twisting; vessel stump endurance was analyzed through different methods. Second, AEs associated with clinical stapler use for pulmonary vessels were retrospectively reviewed by studying clinical videos of 263 patients.
In the animal experiment, the pressure resistance was significantly lower in the twisted group than in the no strain group (no strain lifting: P=0.2008, no strain twisting: P=0.002, no strain . twisting and lifting: P<0.0001). Regarding clinical stapler use, 754 staplers were used against the vessels. AEs occurred in 9 cases, and 7 cases were suspected to be caused by vessel tension.
The pulmonary vessel stapling causes stress due to twisting and lifting that decreased stump durability. Avoiding such stress when using stapler for vessels leads to a safer thoracic surgery.
肺血管吻合器的发展进步有助于胸外科手术的安全与便捷。然而，血管吻合过程中可能发生不良事件（AE）并导致致命性出血。我们旨在评估使用血管吻合术的风险水平，以减少此类不良事件。
首先，进行了一项使用猪心肺阻断的动物实验。在诸如提起或扭转等应激条件下，用吻合器闭合肺动脉；通过不同方法分析血管残端的耐受性。其次，通过研究263例患者的临床视频，回顾性分析与临床使用肺血管吻合器相关的不良事件。
在动物实验中，扭转组的耐压性明显低于无应变组（无应变+提起：P=0.2008，无应变+扭转：P=0.002，无应变+扭转及提起：P<0.0001）。关于临床使用吻合器，共对血管使用了754个吻合器。发生不良事件9例，其中7例怀疑是由血管张力引起的。
肺血管吻合因扭转和提起而产生应力，这会降低残端的耐用性。在使用血管吻合器时避免此类应力可使胸外科手术更安全。
