Xiao Liang, Wang Zhiming, Zhou Ledu
Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China.
Ann Transl Med. 2020 Jun;8(12):744. doi: 10.21037/atm-20-3019.
Nowadays, much effort has been made to optimize the technique for liver parenchyma transection to reduce intrasurgical hemorrhage and complications. Here we intent to introduce a novel method for sharp liver parenchyma transection using scissors and bipolar electrocoagulator (named the snip-electrocoagulation technique, SET) and compare it with the classical clamp-crushing technique (CCT).
In this retrospective study, 98 patients were divided into either the SET group or the CCT group. The total inflow occlusion time, total surgery time, intrasurgical blood loss and transfusion, morbidity, mortality, hospital stay, and the narrowest tumor-free margins were compared.
Background characteristics in the two groups were comparable, and the differences of total inflow occlusion time (median 25 27 minutes), total surgery time (median 182.5 190 minutes), blood transfusion amount (median value 0 in both groups), postoperative hospital stay (median 7 8 days), and overall complication rate (16% 31.2%, P>0.05) were not statistically significant. However, the SET group yielded less intrasurgical blood loss (median 200 300 mL), and better tumor-free margins (13.69±2.99 10.76±3.31 mm; mean ± SD; P<0.05).
SET is a safe method for sharp parenchyma transection in liver resection when compared with the classical CCT, considering the similar morbidity and mortality, along with the decreased intrasurgical blood loss. More importantly, SET can be adopted when the tumors are located close to the intrahepatic vessels and the tumor-free margins are expected to be limited.
如今，人们已做出诸多努力来优化肝实质离断技术，以减少术中出血及并发症。在此，我们旨在介绍一种使用剪刀和双极电凝器进行锐利肝实质离断的新方法（称为剪 - 电凝技术，SET），并将其与传统的钳夹粉碎技术（CCT）进行比较。
在这项回顾性研究中，98例患者被分为SET组或CCT组。比较两组的总入肝血流阻断时间、总手术时间、术中出血量及输血量、发病率、死亡率、住院时间以及最窄切缘宽度。
两组的背景特征具有可比性，总入肝血流阻断时间（中位数25对27分钟）、总手术时间（中位数182.5对190分钟）、输血量（两组中位数均为0）、术后住院时间（中位数7对8天）以及总体并发症发生率（16%对31.2%，P>0.05）的差异无统计学意义。然而，SET组术中出血量更少（中位数200对300 mL），切缘情况更好（13.69±2.99对10.76±3.31 mm；均值±标准差；P<0.05）。
与传统的CCT相比，SET是肝切除术中进行锐利实质离断的一种安全方法，考虑到其发病率和死亡率相似，且术中出血量减少。更重要的是，当肿瘤靠近肝内血管且预计切缘有限时可采用SET。
