局部麻醉下Milligan-Morgan和Ligasure混合痔手术的对比分析

目的：探讨局部麻醉下外剥内扎术（Milligan‐Morgan）和血管闭合系统（Ligasure）两种不同混合痔切除术的临床疗效。方法选择2009年4月至2012年4月首都医科大学附属北京世纪坛医院普通外科行混合痔切除手术住院患者68例,分为Ligasure手术治疗34例（观察组）和Milligan‐Morgan治疗34例（对照组）,手术均采用局部浸润麻醉,术后随访6～36个月,比较两种手术方式的手术时间,术中出血量,总住院费用,术后住院时间、疼痛程度及并发症情况。结果对照组、观察组平均手术时间分别为（32．35±10．24）、（20．29±7．88）min,平均术中出血量分别为（29．71±14．67）、（4．97±2．89）mL,平均术后疼痛（最剧烈）分数分别为（5．88±1．12）、（3．47±0．83）分,平均术后住院时间分别为（7．97±2．55）、（2．29±1．17）d,平均住院费用分别为（1541．32±205．91）、（2872．32±652．30）元,两组比较均差异有统计学意义（P＜0．01）。住院期间及随访中,除对照组肛门渗液率和术后疼痛评分较观察组高外（P＜0．01）;两组其他并发症发生率比较,均差异无统计学意义（P＞0．05）。结论Ligasure术中出血量少,手术时间及术后住院时间短。     

Haemorrhoidectomy with Ligasure™vs conventional excisional techniques: meta‐analysis of randomized controlled trials

Objective To compare the use of LigaSure devices with conventional excisional techniques, circular stapling and use of Harmonic Scalpel in patients with symptomatic haemorrhoids and to review literature on LigaSure technology (Valleylab Inc. USA). Method A literature review was performed using the National Library of Medicine’s Pubmed Database using the keywords Ligasure, haemorrhoidectomy, vessel sealing technology. Randomized trials comparing LigaSure with other techniques of excisional haemorrhoidectomy with valid end points were reviewed in the present article and included in a quantitative meta‐analysis. Results There was no significant difference in the proportion of patients cured after Ligasure haemorrhoidectomy or other excisional techniques (P > 0.05). Patients treated with LigaSure had a significantly shorter operative time (P < 0.001), postoperative pain VAS Score (P < 0.001), wound healing time and time‐off from work (P < 0.001), than the patients submitted to excisional techniques. Postoperative bleeding did not significantly differ between the two groups (P = 0.056); however, the surgeons observed a reduction of intra‐ and postoperative bleeding using LigaSure?. In comparison to the circular stapler and Harmonic Scalpel the authors found similar postoperative outcomes and a slightly favourable trend for LigaSure regarding postoperative complications, ease of handling and length of the procedure. Conclusion Our meta‐analysis shows that Ligasure haemorrhoidectomy is a fast procedure characterized by limited postoperative pain, short hospitalization, fast wound healing and convalescence.     

结扎速血管闭合系统在痔切除术中的应用

为探讨结扎速血管闭合系统（Ligasure）在痔切除术中的使用方法,并与传统手术（Milligan—Morgan术）对比进行疗效分析。将58例Ⅲ、Ⅳ期混合痔患者随机分成两组,观察组29例患者在骶麻下用Ligasure实施痔切除术,对照组29例采用传统手术（MilliganMorgan术）,观察两组手术时间、术后恢复时间、术后疼痛和并发症情况。结果显示,两组手术时间、术后恢复时间、术后使用止痛药次数、肛门狭窄及肛门失禁例数均有显著性差异（P〈0．05）。结果表明,Ligasure用于痔切除术具有疗效可靠,手术时间短,患者术后疼痛轻,并发症少等优点。     

比较结扎速血管闭合系统与双极电凝在腹腔镜子宫切除术中的应用

目的 比较结扎速血管闭合系统（Ligasure）与普通双极电凝在腹腔镜子宫切除术中的应用效果及安全性.方法 对80例子宫肌瘤拟行腹腔镜子宫切除术的患者,40例使用结扎速血管闭合系统凝固闭合卵巢和子宫血管,另外40例使用普通双极电凝术凝固闭合卵巢和子宫血管,比较两组间手术时间、术中出血量、术后恢复情况及近期术后并发症的发生情况.结果 对凝固和闭合〈3 mm管径的血管,两组的手术时间、术中出血量无明显差异（P〉0.05）;但对凝固、闭合3～5 mm直径的子宫、卵巢血管,Ligasure组的手术时间、术中出血量均显著少于双极电凝组,差异有统计学意义（P〈0.01）.两组的术中术后并发症及术后恢复情况差异无统计学意义（P〉0.05）.结论 Ligasure、普通双极电凝均能安全、有效地凝固〈3 mm直径的血管,但在结扎速凝固闭合3～5 mm的较大血管时,使用Ligasure更安全、更有效,能减少出血量及缩短手术时间.     

Ligasure在非脱垂子宫经阴道切除术中的应用

目的探讨Ligasure（血管速扎闭合系统）在阴式子宫切除术中的应用的价值。方法从2007年11月至2009年11月,我院对78例非脱垂子宫患者采用Ligasure阴式子宫切除术作为观察组,随机选择同期以传统缝合术进行阴式子宫全切术78例作为对照组。比较2组手术时间、术中出血量及术后恢复情况。结果手术时间,观察组为（38±22）min,对照组为（68±35min）,P〈0.01;术中出血量,观察组为（93±85）mL,对照组为（152±108）mL,P〈0.01;平均术后住院时间,观察组为5.2d,对照组为5.5d,P〉0.05;术后3个月阴道残端情况,观察组愈合良好,对照组5例发现阴道残端,可见线头或肉芽。结论采用Ligasure的改良非脱垂子宫经阴道切除术具有手术时间短、术中出血量少、术后并发症少、操作简单、安全可靠、病人恢复快及易被患者接受,值得临床推广。     

Ligasure血管闭合系统在腹膜后肿瘤切除中的应用

目的 探讨Ligasure血管闭合系统(LVSS)在腹膜后肿瘤切除手术中的应用价值.方法 对2004年6月至2008年10月32例采用LVSS联合电刀切除腹膜后肿瘤,在术中出血、手术时间、手术副损伤、术后渗血、住院时间方面与2001年1月至2004年6月间26例用电刀进行的相应手术进行比较.结果 LVSS联合电刀组与电刀组的手术副损伤(9.38%与16.00%)、住院时间[(11.7±0.7)d与(12.3±1.4)d)]差异均无统计学意义(P均＞0.05);但两组的术中出血[(403.1±37.1)ml与(704.0±129.0)m1)]、术后渗血[(131.5±18.4)ml与(214.8±29.2)ml)]、手术时间[(166.5±8.9)min与(186.8±15.4)min]差异均有统计学意义(P均＜0.05),而且对于深部手术操作和手术盲点的分离Ligasure有独到的优势.结论 Ligasure血管闭合系统在腹膜后肿瘤切除手术中具有止血确切、手术时间缩短和便于深部手术操作及便于手术盲点分离等优点.     

腹腔镜Miles术联合应用Ligasure治疗直肠癌的疗效

 目的 观察腹腔镜Miles术联合应用Ligasure的近期疗效。方法 2013-04至2014-12为38例患者行直肠癌Miles术,其中实验组16例(腹腔镜联合LigaSure组),对照组22例(传统开腹组),记录分析两组患者术中情况包括手术总时间、会阴组手术时间、术中出血量;术后情况包括通气时间、术后住院天数、淋巴结清扫数量、会阴部伤口甲级愈合率及术后疼痛评分。结果 实验组少于对照组的有术中总出血量[(125.3±25.9) ml vs(206.3±34.3 )ml]、会阴组手术时间[(26.2±3.4) min vs(35.3±5.2 )min]、通气时间[(51.6±13.9 h)vs(77.4±12.6 h)]、术后住院天数[(11.9±2.6 d)vs(14.7±3.4 d)]和术后疼痛评分[(5.6±2.3 cm)vs(6.9±1.8 cm)], 差异有统计学意义(P<0. 05);而实验组手术总时间(162.6±23.0 min)多于对照组(195.1±27.9 min),差异有统计学意义(P<0. 05)。实验组淋巴结清扫数量(14.3±3.5)与对照组(13.8±3.5)相比,差异无统计学意义。结论 腹腔镜Miles术联合应用Ligasure治疗直肠癌具有术后疼痛轻、恢复快、切口感染率低等优点,且近期疗效好,值得做进一步研究和推广。     

Randomized study of bipolar vessel sealing system versus conventional suture ligature for vaginal hysterectomy

Objective

This study was undertaken to compare the use of bipolar vessel sealing system (BVSS) with conventional suture ligature in vaginal hysterectomy (VH) on a non-prolapsed uterus.

Study design

Women referred for VH for uterine myoma were randomized to BVSS (n = 45) or conventional suture ligature VH (n = 45). Exclusion criteria were uterine prolapse and indication associated surgical procedures. Main outcome measures were operative time, blood loss, hospital stay, pain status, peri and post-operative complications. Data of patients were collected prospectively. Statistical analysis was performed using chi-square and Student's t-test as appropriate.

Results

There were no differences in patients’ mean age, parity and uterine size between groups. Patients in the BVSS group had a significantly reduced operating time (29.2 ± 2.1 min vs. 75.2 ± 5 min; p < 0.001), operative blood loss (84 ± 5.9 mL vs. 136.4 ± 89.1 mL; p = 0.001), requirement of surgical sutures (1.2 ± 0.6 units vs. 7.4 ± 0.3 units; p < 0.001), pain status (1.6 ± 0.4 vs. 3.6 ± 0.4; p < 0.001) and hospital stay (25.6 ± 0.9 h vs. 33.2 ± 1.7 h; p < 0.001) compared to the control group. The overall complication rate in the study was 7.8% (7/90), and did not differ between patients of the BVSS and control group.

Conclusion

Bipolar vessel sealing for vaginal hysterectomy appears to be an effective and safe haemostatic control method, with reduced operating time, peri-operative blood losses, post-operative pain and hospital stay.     

Ligasure血管闭合系统在痔切除术中的应用概况

L igasure血管闭合系统(LVSS)应用实时反馈技术和智能主机技术共同完成闭合血管的作用。主机在血管闭合钳口将血管束闭合完全后自动发出反馈信息,提示操作者血管闭合完全。L igasure血管闭合系统输出高频电能结合血管闭合钳口压力,使血管壁、组织束内的胶原蛋白、纤维蛋白共同溶解变性,血管壁被融合形成一透明带,使血管管腔闭合。L i-gasure血管闭合系统的最大优点是术中及术后出血极少[1-2],且产生的焊接闭合带比其他所有以能量为基础的融合方式都坚固,可达到与缝线结扎相似的强度,可承受3倍的正常收缩压,可闭合直径7 mm以内的任何动、静脉[3]。由于本系统的热传导距离为0.5~2.0