- 作者：Atsushi Nanashima ; Takafumi Abo ; Junichi Arai ; Katsunori Takagi ; Hirofumi Matsumoto ; Hiroaki Takeshita ; Tomoshi Tsuchiya ; Takeshi Nagayasu
- 关键词：Hepatectomy ; Vessel sealing ; Crush clamping ; Bloodless ; morbidity ; Cohort study
- 刊名：International Journal of Surgery
- 出版年：2013
- 年：2013
- 卷：11
- 期：9
- 页码：891-897
- 全文大小：655 K
Background
Blood loss during resection of the hepatic parenchyma in hepatectomy can be minimized using vessel-sealing (VS) devices. Some sealing devices were retrospectively compared to evaluate the efficacy of each device for controlling blood loss, transection time and postoperative complications in hepatectomy as a cohort study.Methods
Between 2005 and September 2012, hepatectomy was underwent in 150 patients using one of three types of LigaSure鈩?(Dolphin Tip Laparoscopic Instrument, Precise or Small Jaw) or the Harmonic Focus or Ace ultrasonic dissecting sealer. Results were compared to crush-clamping alone as the control method by the historical study (n聽=聽81).
Results
Irrespective of the vessel-sealing device used for underlying chronic hepatitis, blood loss, blood transfusion rate, operating time and transection time were significantly reduced in the VS group compared with controls (p聽<聽0.05). Rates of postoperative bile leakage and intra-abdominal abscess formation were significantly lower in the VS group than in controls (p聽<聽0.05). Comparing devices, LigaSure Small Jaw and Harmonic Focus showed lower blood loss, shorter transection time and reduced rates of post-hepatectomy complications, in turn resulting in shorter hospital stays (p聽<聽0.05). Tendencies toward uncontrolled ascites and bile leakage were only concern with the use of Harmonic Focus. Satisfactory surgical results were achieved using the sealing device for laparoscopic hepatectomy.
Conclusions
The use of energy sealing devices improves surgical results and avoids hepatectomy-related complications. Adequate use of vessel sealers is necessary for safe and rapid completion of hepatic resection.