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Comparative Study for Surgical Hepatectomies Done by CCC and CUSA+EBVS

Hasan Manzoor  
【摘要】:BACKGROUND: Liver resection is a demanding procedure due to the risk of massive blood loss, intra operative and post operative complications, bile leakage, hospitalization stay and post operative infection. These days various kinds of surgical instruments can be used but there are numerous well-known risk factors for morbidity and mortality during liver resection. Bleeding usually occurs during parenchymal resection, and surgical technique should be considered an important factor in preventing intra operative and post operative complications. Aim: The aim of this randomized clinical trial was to compare and measure the efficacy of EBVS+CUSA with traditional CCC used for hepatectomies. Which one can provide safer and careful liver resections without routine inflow occlusion, while achieving a satisfactory hemostasis and bile stasis, thus reducing blood loss and bile leak and related complications Objectives: To Analyze and evaluate, the effectiveness and performance of the Two-Surgeon technique using CUSA+EBVS with the conventional Classic crushing clamp CCC for hepatectomies done in cirrhotic and non cirrhotic patients. This Prospective randomized study was done to conduct the end points as blood-loss, duration of surgery, ICU stay, liver functions before/after the surgery, post operative infection and hospital stay. Methods: From the period of2010to2012, total of60randomized clinical patients underwent the procedure for hepatectomy. Patients were divided into two groups according to the device used for hepatectomy. Patients underwent classic crushing clamp technique (CCC) was assigned to Group A (n=30) and patients who underwent two surgeons technique using cavitron ultrasonic aspirator plus electrothermal bipolar vessel sealing system (CUSA+EBVS) was assigned to Group B (n=30). No other devices were applied to achieve hemostasis. Results: Mean age in both groups were54.20±14.33years in Group A and49.27±8.44years in Group B. Overall the mean surgery duration was shorter in Group A (214.9±77.79) than Group B (292.1±99.071)(p=0.003). In Group B the mean volumes of bleeding (396.67±188.89ml, p=0.007) and blood transfusion (320±444.43ml, p=0.023) were markedly less than those in group A (788.67±732.59ml, p=0.007and636.67±767.66ml, p=0.023respectively). The mean hospitalization time and ICU stay of Group B (15.7±4.252d and314.33±373.026min.) was markedly reduced than that of Group A(20.8d±8.475d and736.73±853.029min. P=0.005and p=0.012respectively). There was No significant differences observed in ALT changes before and after the surgery, Child Pugh score, ascites, infection, bile leakage, cirrhosis, age or gender (p0.05). CONCLUSION: After the analysis it is concluded that two-surgeon technique using CUSA+EBVS compared with CCC, could evidently reduce the operative injury, intra operative blood loss, infusion and also shorten the ICU and hospitalization time. But comparatively duration of surgery is longer while using CUSA+EBVS than CCC. Liver resections can be performed safely if the entire concept is well designed but the choice of dissection device still holds some critical importance.

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