Ligasure 对减少巨量体重减轻患者腹部整形术后出血量、并发症和再次手术发生率的影响：一项比较研究。

Ligasure impact might reduce blood loss, complications, and re-operation occurrence after abdominoplasty in massive-weight-loss patients: A Comparative Study.

机构信息

Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland.

Department of Surgery, Satakunta Central Hospital, Pori, Finland.

出版信息

Scand J Surg. 2020 Jun;109(2):151-158. doi: 10.1177/1457496919828237. Epub 2019 Feb 14.

DOI:10.1177/1457496919828237

PMID:30760107

Abstract

BACKGROUND AND AIMS

The most effective dissection technique for raising the flap in abdominoplasty is still controversial, particularly in high-risk massive-weight-loss patients. LigaSure Impact vessel-sealing system (Medtronic, Dublin, Ireland) is an energy device commonly used among different surgical specialties to reduce morbidity and implement outcomes. The aim of this study was to investigate the effectiveness of LigaSure Impact in abdominoplasty compared with the conventional techniques, diathermia.

MATERIAL AND METHODS

Patients underwent primary abdominoplasty after massive weight loss at a single center from 1 January 2008 to 31 May 2015 and were retrospectively reviewed. A total of 94 patients eligible for the study were divided into two groups on basis of the dissection technique: LigaSure Impact group (29 patients) and the conventional technique group (65 patients). Total intraoperative blood loss was the primary endpoint. Duration of the operation, perioperative complications and re-operation were recorded as secondary endpoints.

RESULTS

Baseline characteristics were well balanced between the groups. Significant differences were found in intraoperative blood loss favoring LigaSure Impact group (259.6 ± 198.8 mL vs 377.9 ± 190.0 mL, p = 0.004) and blood transfusion rates (13.8% vs 35.4%, p = 0.047). In contrast, operative time was significantly longer in LigaSure Impact group (168.6 ± 121.2 vs 179.7 ± 57.6 min, p = 0.005), while a tendency to shorter hospital stay was found in LigaSure Impact group (3.6 ± 1.1 days vs 4.6 ± 3.2 days, p = 0.081). Overall complications occurrence, Clavien-Dindo grade II (24.1% vs 55.4%) and grade III (13.8% vs 30.8%) complications were significantly lower in LigaSure Impact group (respectively, p = 0.005, p = 0.007, p = 0.016). Late (>30 days) re-operation rate was significantly lower in the LigaSure Impact group (6.9% vs 27.70%, p = 0.0028). Specific wound complications showed no significant difference.

CONCLUSION

LigaSure Impact vessel-sealing system may be beneficial in improving abdominoplasty outcomes in massive-weight-loss patients because it might reduce blood loss, need for transfusions, complications, and re-operations.

摘要

背景与目的

在腹部整形术（abdominoplasty）中，提高皮瓣的最有效解剖技术仍存在争议，尤其是在高危大体重减轻患者中。LigaSure Impact 血管密封系统（Medtronic，都柏林，爱尔兰）是一种常用于不同外科专业的能量设备，可降低发病率并实现预期结果。本研究旨在调查 LigaSure Impact 在腹部整形术与传统技术（电凝术）相比的效果。

材料与方法

2008 年 1 月 1 日至 2015 年 5 月 31 日，在一家单中心进行了大体重减轻后的原发性腹部整形术，对患者进行了回顾性分析。共有 94 名符合研究条件的患者按解剖技术分为两组： LigaSure Impact 组（29 例）和传统技术组（65 例）。总术中失血量为主要终点。记录手术时间、围手术期并发症和再次手术作为次要终点。

结果

两组患者的基线特征相当。术中出血量显著减少（259.6 ± 198.8 mL 比 377.9 ± 190.0 mL，p = 0.004），输血率降低（13.8%比 35.4%，p = 0.047），LigaSure Impact 组具有统计学意义。相比之下，LigaSure Impact 组的手术时间明显延长（168.6 ± 121.2 比 179.7 ± 57.6 分钟，p = 0.005），而 LigaSure Impact 组的住院时间有缩短趋势（3.6 ± 1.1 天比 4.6 ± 3.2 天，p = 0.081）。LigaSure Impact 组总体并发症发生率、Clavien-Dindo 分级 II（24.1%比 55.4%）和 III 级（13.8%比 30.8%）并发症明显降低（分别为 p = 0.005、p = 0.007、p = 0.016）。LigaSure Impact 组迟发性（>30 天）再次手术率显著降低（6.9%比 27.7%，p = 0.0028）。特定的伤口并发症无显著差异。