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首页> 外文期刊>Surgical Endoscopy >Liver resection with intraoperative and laparoscopic ultrasound: report of 32 cases : Ultrasonic shears device for liver parenchymal transection.
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Liver resection with intraoperative and laparoscopic ultrasound: report of 32 cases : Ultrasonic shears device for liver parenchymal transection.

机译：术中和腹腔镜超声检查肝切除术：32例报道：超声剪切装置用于肝实质横切术。

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BACKGROUND: Careful staging of hepatic tumors is mandatory for appropriate selection of patients for liver resection. Number and relationships of liver nodules are issues of utmost importance when evaluating resectability. Sensitivity of preoperative imaging for secondary lesions has been reported between 60-75% with spiral contrast-enhanced computed cosmography (CT), 80-85% with magnetic resonance imaging (MRI), and 90-96% with intraoperative ultrasound (IOUS). Also for primary lesions IOUS has been reported to allow detection of liver nodules in 17% and modify surgical strategy in 10%. The aim of this study was to point out the usefulness of open (IOUS) and laparoscopic (LIOUS) ultrasound in patients undergoing hepatic surgery for liver tumors. METHODS: In the years 2004-2006, 50 patients, mean age 66 years (range 44-76 years) were evaluated for resective surgery at the General Surgery Department of Monaldi Hospital, Naples, Italy. All of them were studied with biphasic CT and transabdominal ultrasound. Eighteen (36%) were judged unresectable. The others were scheduled for laparoscopy and LIOUS, by means of an ALOKA SSD-5500 (Aloka Co. Ltd. Tokyo, Japan), equipped with linear flexible tip laparoscopic probe. RESULTS: Six patients (18.7%) were excluded because of pathology diffusion; 26 (81.3%) were resected, using ultrasonic shears (Harmonic ACE, Ethicon Endo-Surgery, Cincinnati Oh., USA) for parenchymal transection, 3 (11.5%) laparoscopically and 23 (88.5%) after laparotomy. IOUS was repeated in the latter group. LIOUS spared useless laparotomies in six patients (18.7%) and, coupled with IOUS, found undetected nodes in five patients (19.2%), changing surgical strategy in three patients (11.5%). CONCLUSION: In our experience LIUOS and IOUS proved to be of utmost importance both in the selection of patients for resective surgery and in planning surgical approach. Ultrasonic shears device and systematic pedicle clamping sped up resection time and reduced intraoperative bleeding.
机译：背景：肝肿瘤的仔细分期对于强制选择要进行肝切除的患者是必不可少的。在评估可切除性时，肝结节的数量和相互关系是最重要的问题。据报道，术前影像学检查对继发性病变的敏感性在使用螺旋造影增强型计算机X线照相术（CT）时为60-75％，在磁共振成像（MRI）中为80-85％，在术中超声（IOUS）中为90-96％。同样，对于原发性病变，有报道称IOUS可以检测到17％的肝结节，而10％的可以改变手术策略。这项研究的目的是指出开放（IOUS）和腹腔镜（LIOUS）超声在接受肝癌手术的肝肿瘤患者中的有用性。方法：在2004-2006年间，对意大利那不勒斯莫纳尔迪医院普通外科的50例平均年龄为44-76岁的患者进行了切除手术。所有患者均接受了双相CT和腹部超声检查。 18名（36％）被裁定为无法切除。其余的则通过配备线性柔性尖端腹腔镜探头的ALOKA SSD-5500（日本东京的Aloka公司）进行腹腔镜检查和LIOUS检查。结果：由于病理扩散，排除了6例患者（占18.7％）。使用超声剪（Harmonic ACE，Ethicon Endo-Surgery，俄亥俄州辛辛那提，美国）切除26例（81.3％）进行实质性横切，腹腔镜手术切除3例（11.5％），剖腹手术后切除23例（88.5％）。在后一组中重复了IOUS。 LIOUS挽救了6例患者（18.7％）的无用的开腹手术，并与IOUS一起在5例患者（19.2％）中发现了未被发现的淋巴结转移，改变了3例患者（11.5％）的手术策略。结论：根据我们的经验，LIOUOS和IOUS在选择切除手术的患者和计划手术方法方面都具有至关重要的意义。超声剪装置和系统的椎弓根夹紧缩短了切除时间并减少了术中出血。

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