Significance of a soft-coagulation system with monopolar electrode for hepatectomy: A retrospective two-institution study by propensity analysis
Significance of a soft-coagulation system with monopolar electrode for hepatectomy: A retrospective two-institution study by propensity analysis
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DOI：
10.1016/j.ijsu.2017.07.101
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发表时间：
2017-09-01
影响因子：
15.3
通讯作者：
Nagayasu, Takeshi
中科院分区：
文献类型：
--
作者：
Hamada, Takeomi;Nanashima, Atsushi;Nagayasu, Takeshi
背景：单极电极VIO软凝系统（VIO）是一种新型的止血装置，通过在出血部位表面接触而不碳化止血。由于热损伤仍然是一个问题，在一项队列研究中回顾性评估了手术记录和术后肝功能障碍。方法：2010年9月至2016年3月，322例患者在两家医院接受了肝切除术，其中使用了止血装置。将在一家机构使用VIO的手术结果（VIO组）与在另一家机构未使用VIO的手术结果（对照组）进行比较，并进行倾向分析。结果：VIO组行部分切除或部分切除时，肝硬化发生率明显高于对照组，手术时间明显长于对照组（p < 0.05）。在所有肝切除术中，VIO组术后总胆红素水平、天冬氨酸转氨酶或丙氨酸转氨酶水平均有升高趋势，凝血酶原活性有降低趋势（p < 0.05）。VIO组肝功能衰竭发生率明显高于对照组（p < 0.05）。在节段切除或部分切除的情况下，VIO组出血量较对照组明显增加（p < 0.05）倾向评分匹配显示，虽然两组间的手术记录和结局无显著差异，但VIO组术后肝功能较对照组显著（p < 0.05）。结论：VIO术后肝热损伤轻微，外科医生在使用VIO系统时应注意频繁在肝表面进行宽切口切除。2017ijs出版集团有限公司Elsevier Ltd.出版。版权所有。
Background: The VIO soft-coagulation system (VIO) with a monopolar electrode is a novel hemostatic device that provides hemostasis by superficial contact at the bleeding site without carbonization. Because heat injury remains a concern, surgical records and postoperative liver dysfunction were retrospectively evaluated in a cohort study.Methods: Between September 2010 and March 2016, 322 patients underwent hepatectomy in which hemostatic devices were used at two institutions. Surgical results with use of VIO at one institute (VIO group) were compared with those without use of VIO at a second institute (control group), and propensity analysis was performed.Results: In limited resection and segmentectomy or sectionectomy performed in the VIO group, the prevalence of liver cirrhosis was significantly higher and the operation time was significantly longer in comparison with the control group (p < 0.05). In all hepatectomies, postoperative levels of total bilirubin and aspartate or alanine transaminase tended to be increased and prothrombin activity tended to be lower in the VIO group in comparison with the control group (p < 0.05). The prevalence of hepatic failure in the VIO group was significantly higher in comparison with that in the control group (p < 0.05). In cases of segmentectomy or sectionectomy, blood loss was significantly increased in the VIO group in comparison with that in the control group (p < 0.05) Propensity score matching showed that although the surgical records and outcomes were not significantly different between the groups, postoperative liver dysfunction was significant in the VIO group in comparison with the control group (p < 0.05).Conclusions: Mild postoperative hepatic thermal injury with VIO was confirmed, and therefore, surgeons should take care when using the VIO system to make frequent wide resected cuts on the surface of the liver. (C) 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.