Water-jet dissection for parenchymal division during hepatectomy.
Water-jet dissection for parenchymal division during hepatectomy.
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DOI：
10.1080/13651820600839449
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发表时间：
2006-01-01
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影响因子：
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通讯作者：
Greig, Paul D
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作者：
Vollmer, Charles M;Dixon, Elijah;Greig, Paul D
背景：高压水射流切割最初是为需要超精密切割和雕刻的工业而开发的。该技术已适应于医学应用，并取得了良好的结果，但对其在肝脏切除术中的表现知之甚少。薄层流液体喷射效应可提供精确、可控、组织选择性剥离，具有良好的可视化效果，对周围纤维结构的创伤最小，从而限制了失血。患者和方法：在连续11个月的101例肝切除（包括22例活体供体移植切除）病例系列中，研究了水射流系统对肝实质解剖的疗效。评估围手术期结果，包括出血量、输血要求、并发症和住院时间（LOS）。结果：四分之三的病例为大肝切除术，22%为肝硬化。恶性肿瘤是最常见的适应症（77%）。中位手术时间289 min。所有病例的中位估计失血量（EBL）为900毫升，只有14%的患者的EBL为2000毫升。此外，大切除患者EBL为1000 ml，活体供体切除患者EBL为775 ml，肝硬化患者EBL为600 ml，脂肪肝患者EBL为1950 ml。总的来说，14%的患者接受了异源填充红细胞（PRBC）输血，平均每例0.59单位。平均生存期为7天。在主要切除组中，EBL、输血需求和LOS略有增加。总体上有1例死亡（1%）。这些结果相当于或优于我们当代用超声解剖进行的一系列切除。结论：水射流解剖减少了大血量损失、输血需求和并发症。这一初步经验表明，这种精密工具对肝脏分割是安全有效的，与其他已建立的肝实质横断方法相比，它具有优势。
BACKGROUND: High-pressure water-jet dissection was originally developed for industry where ultra-precise cutting and engraving were desirable. This technology has been adapted for medical applications with favorable results, but little is understood about its performance in hepatic resections. Blood loss may be limited by the thin laminar liquid-jet effect that provides precise, controllable, tissue-selective dissection with excellent visualization and minimal trauma to surrounding fibrous structures.PATIENTS AND METHODS: The efficacy of the Water-jet system for hepatic parenchymal dissection was examined in a consecutive case series of 101 hepatic resections (including 22 living donor transplantation resections) performed over 11 months. Perioperative outcomes, including blood loss, transfusion requirements, complications, and length of stay (LOS), were assessed.RESULTS: Three-quarters of the cases were major hepatectomies and 22% were cirrhotic. Malignancy was the most common indication (77%). Median operative time was 289 min. Median estimated blood loss (EBL) was 900 ml for all cases, and only 14% of patients had >2000 ml EBL. Furthermore, EBL was 1000 ml for major resections, 775 ml for living donor resections, 600 ml in cirrhotic patients, and 1950 ml for steatotic livers. In all, 14% of patients received heterologous packed red blood cell (PRBC) transfusions for an average of 0.59 units per case. Median LOS was 7 days. EBL, transfusion requirements, and LOS were slightly increased in the major resection cohort. There was one mortality (1%) overall. These results are equivalent to, or better than, those from our contemporary series of resections performed with ultrasonic dissection.CONCLUSION: Water-jet dissection minimizes large blood volume loss, requirements for transfusion, and complications. This initial experience suggests that this precision tool is safe and effective for hepatic division, and compares favorably to other established methods for hepatic parenchymal transection.