Ottow R T, Barbieri S A, Sugarbaker P H, Wesley R A
Surgery. 1985 May;97(5):596-601.
The optimal method of transecting liver parenchyma has not been established and presently a variety of methods are in use. In a controlled study in pigs standard resections were performed with four different transection techniques: ultrasonic dissection, suction dissection, electrocautery, and sharp dissection. The blood loss, number of vessels identified before their division, need for additional hemostatic measures, and time for each procedure were evaluated. Also, the histologic appearance of the fresh and the healing cut surface of the liver was studied. The blood loss was the lowest when ultrasonic dissection was used (median blood loss of 58 ml per resection). The comparisons with suction dissection (median blood loss of 87 ml) and cautery (median blood loss of 79 ml) were not significant. The ultrasonic and suction dissection techniques were both effective in isolating vessels, but the ultrasonic dissector did this more atraumatically. Cautery and ultrasonic dissection had a hemostatic effect on the parenchyma in that a significantly smaller number of vessels needed to be clipped or tied. On histologic study of the fresh cut liver surface, a smooth surface was seen with ultrasonic dissection, parenchymal hemorrhage after suction dissection, and coagulation necrosis after electrocautery. Ultrasonic dissection was the only technique that combined lowered blood loss because medium- and large-size vessels were dissected free and ligated before transection and a hemostatic effect on small vessels.
肝实质横断的最佳方法尚未确定，目前有多种方法在使用。在一项对猪的对照研究中，采用四种不同的横断技术进行标准切除术：超声解剖、吸引解剖、电灼和锐性解剖。评估了失血量、血管离断前识别出的血管数量、额外止血措施的需求以及每个手术的时间。此外，还研究了肝脏新鲜切面和愈合切面的组织学外观。使用超声解剖时失血量最低（每次切除的中位失血量为58毫升）。与吸引解剖（中位失血量为87毫升）和电灼（中位失血量为79毫升）相比，差异不显著。超声解剖和吸引解剖技术在分离血管方面均有效，但超声解剖器操作时创伤更小。电灼和超声解剖对肝实质有止血作用，因为需要夹闭或结扎的血管数量明显减少。对新鲜肝脏切面进行组织学研究时，超声解剖可见表面光滑，吸引解剖后有实质内出血，电灼后有凝固性坏死。超声解剖是唯一一种既因在横断前游离并结扎了中、大型血管而降低失血量，又对小血管有止血作用的技术。
