Laparoscopic control of short gastric vessels
Laparoscopic control of short gastric vessels
复制标题
腹腔镜控制胃短血管
DOI：
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发表时间：
1995
影响因子：
5.2
通讯作者：
Pennings Jl
中科院分区：
文献类型：
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作者：
Swan Ll;Pennings Jl
背景技术背景：尼森胃底折叠术是目前最常用的抗反流手术，无论是开放手术还是腹腔镜手术。开放式Nissen胃底折叠术的丰富经验表明，分离胃短血管以使胃底活动，可确保包裹物松散且无张力。标准的腹腔镜胃底游离技术是解剖出胃短血管，应用止血夹，然后将其分开。对于刚接触腹腔镜手术的外科医生来说，这可能是一项令人生畏的任务。超声波剪切机是一种新的能源技术，它的引入使这一过程变得更快、更容易。研究设计：我们提出了一项随机前瞻性研究，比较腹腔镜胃底折叠术中结扎胃短血管的两种方法。31例患者入组并随机分为两组：通过解剖、夹闭和分割进行胃短结扎的患者，以及使用超声腹腔镜手术剪的患者。将结果制成表格并进行统计分析。研究结果：15例患者采用腹腔镜胃底折叠术，其中16例采用超声刀结扎胃短血管。两组之间没有人口统计学差异，两组中结扎的胃短血管数量相同。中位手术时间在短胃控制（夹闭22分钟，超声剪12分钟）、中位失血量（夹闭70 mL，超声剪2.5 mL）和技术难度（夹闭93%，超声剪19%）方面具有显著性。结论：根据这项随机前瞻性研究的结果，超声刀更易于使用，术中“并发症”和术后发病率较低。我们相信，这项新技术将使外科医生在腹腔镜胃底折叠术中更容易和更可取地游离胃底。
BACKGROUND: The Nissen fundoplication is currently the most commonly performed antireflux surgery whether performed as an open procedure or through the laparoscope. Extensive experience with open Nissen fundoplication has shown that dividing the short gastric vessels to mobilize the fundus ensures that the wrap will be loose and without tension. The standard laparoscopic technique for fundal mobilization is dissecting out the short gastric vessels, applying hemoclips, and then dividing them. For surgeons new to laparoscopic surgery, this can be an intimidating task. Introduction of the ultrasonic coagulating shears, a new energy source technology, offered the possibility of making this process quicker and easier. STUDY DESIGN: We present a randomized prospective study comparing two methods of ligating the short gastric vessels during laparoscopic fundoplication. Thirty-one patients were enrolled and randomized into two groups: those who underwent short gastric ligation by dissection, clipping, and dividing, and those in whom the ultrasonic laparoscopic coagulating shears were used. The results were tabulated and subjected to statistical analysis. RESULTS: Fifteen patients had laparoscopic fundoplication with ligation of the short gastric vessels by using clips and 16 by using the ultrasonic coagulating shears. There was no demographic difference between the two groups and the number of short gastric vessels ligated was the same in both groups. Significance was seen for the median operating time for short gastric control (22 minutes for clipping versus 12 minutes for coagulating shears), median blood loss (70 mL for clipping versus 2.5 mL for the ultrasonic coagulating shears), and technical difficulty (93 percent with clipping versus 19 percent with the coagulating shears). CONCLUSIONS: Based on the results from this randomized prospective study, the ultrasonic coagulating shears are easier to use and less prone to intraoperative "complications" and postoperative morbidity. We believe that this new technology will make it easier and more desirable for surgeons to mobilize the gastric fundus during laparoscopic fundoplication.