Intervention Review

Techniques for liver parenchymal transection in liver resection

  1. Kurinchi Selvan Gurusamy*,
  2. Viniyendra Pamecha,
  3. Dinesh Sharma,
  4. Brian R Davidson

Editorial Group: Cochrane Hepato-Biliary Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 26 MAR 2008

DOI: 10.1002/14651858.CD006880.pub2


How to Cite

Gurusamy KS, Pamecha V, Sharma D, Davidson BR. Techniques for liver parenchymal transection in liver resection. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD006880. DOI: 10.1002/14651858.CD006880.pub2.

Author Information

  1. Royal Free Hospital and University College School of Medicine, University Department of Surgery, London, UK

*Kurinchi Selvan Gurusamy, University Department of Surgery, Royal Free Hospital and University College School of Medicine, 9th Floor, Royal Free Hospital, Pond Street, London, NW3 2QG, UK. kurinchi2k@hotmail.com.

Publication History

  1. Publication Status: New
  2. Published Online: 21 JAN 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Blood loss during elective liver resection is one of the main factors affecting the surgical outcome. Different parenchymal transection techniques have been suggested to decrease blood loss.

Objectives

To assess the benefits and risks of the different techniques of parenchymal transection during liver resections.

Search methods

We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded (March 2008).

Selection criteria

We considered for inclusion all randomised clinical trials comparing different methods of parenchymal dissection irrespective of the method of vascular occlusion or any other measures used for lowering blood loss.

Data collection and analysis

Two authors identified the trials and extracted the data on the population characteristics, bias risk, mortality, morbidity, blood loss, transection speed, and hospital stay independently of each other. We calculated the odds ratio (OR), mean difference (MD), or standardised mean difference (SMD) with 95% confidence intervals based on 'interntion-to-treat analysis' or 'available case analysis' using RevMan 5.

Main results

We included seven trials randomising 556 patients. The comparisons include CUSA (cavitron ultrasound surgical aspirator) versus clamp-crush (two trials); radiofrequency dissecting sealer (RFDS) versus clamp-crush (two trials); sharp dissection versus clamp-crush technique (one trial); and hydrojet versus CUSA (one trial). One trial compared CUSA, RFDS, hydrojet, and clamp-crush technique. The infective complications and transection blood loss were greater in the RFDS than clamp-crush. There was no difference in the blood transfusion requirements, intensive therapy unit (ITU) stay, or hospital stay in this comparison. There was no significant differences in the mortality, morbidity, markers of liver parenchymal injury or liver dysfunction, ITU, or hospital stay in the other comparisons. The blood transfusion requirements were lower in the clamp-crush technique than CUSA and hydrojet. There was no difference in the transfusion requirements of clamp-crush technique and sharp dissection. Clamp-crush technique is quicker than CUSA, hydrojet, and RFDS. The transection speed of sharp dissection and clamp-crush technique was not compared. There was no clinically or statistically significant difference in the operating time between sharp dissection and clamp-crush techniques. Clamp-crush technique is two to six times cheaper than the other methods depending upon the number of surgeries performed each year.

Authors' conclusions

Clamp-crush technique is advocated as the method of choice in liver parenchymal transection because it avoids special equipment, whereas the newer methods do not seem to offer any benefit in decreasing the morbidity or transfusion requirement.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Clamp-crush technique seems to be the method of choice in liver parenchymal transection

Liver resection (removal of a part of the liver) is performed mainly for cancerous and non-cancerous tumours in the liver. About 1000 liver resections are performed each year in the United Kingdom. Blood loss during liver resection is one of the main factors affecting the development of surgical complications. Different parenchymal transection techniques (techniques used to divide the liver) have been suggested to decrease blood loss. In this systematic review of seven randomised clinical trials including 556 patients, various methods of parenchymal transection techniques were compared. The infective complications and transection blood loss were greater in the radio frequency dissecting sealer (RFDS ) than clamp-crush technique. There were no significant differences in the mortality or in the morbidity between the other techniques of parenchymal transection. There was also no difference in the markers of liver parenchymal injury or liver dysfunction between the different methods used. Intensive therapy unit stay and hospital stay were similar. The blood transfusion requirements were lower in the clamp-crush technique than CUSA (cavitron ultrasonic surgical aspirator) and hydrojet. There was no difference in the transfusion requirements of clamp-crush technique and sharp dissection. Clamp-crush technique is quicker than CUSA, hydrojet, and RFDS. The transection speed of sharp dissection and clamp-crush technique was not compared. There was no clinically or statistically significant difference in the operating time between sharp dissection and clamp-crush techniques. Clamp-crush technique is two to six times cheaper than the other methods depending upon the number of surgeries performed each year. Clamp-crush technique is advocated as the method of choice in liver parenchymal transection because it avoids the need for special equipment and the newer methods do not seem to offer any benefit in decreasing the morbidity or transfusion requirement.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

肝實質切除的技術用於肝臟切除

選擇性肝臟切除過程中的血液損失是主要影響手術結果的一大因素。各種不同實質切除的方法被應用來減少血液損失。

目標

評估各種不同肝實質切除方法在肝臟切除過程中使用的好處和風險。

搜尋策略

我們搜尋The Cochrane HepatoBiliary Group Controlled Trials Register, Cochrane Library的Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE和Science Citation Index Expanded (2008年3月)。

選擇標準

我們收錄所有比較各種不同實質切除方法的隨機臨床試驗, 不受血管閉塞或其他用來減少血液損失的方法的限制。

資料收集與分析

兩位作者找出試驗並摘錄有關人口特性、誤差風險、死亡率、發病率、失血量、切除摙度和住院天數等數據。 我們根據“治療意向”或“已獲取個案分析”,使用RevMan 5計算odds ratio (OR)、平均差(MD)或平均標準差(SMD) 及其95% 信賴區間。

主要結論

我們總共收錄了7次隨機試驗,共有556 位病人。比較包括CUSA (激光超音波) 對照夾緊壓碎 (2次試驗);射頻切割閉合器 (RFDS) 對照夾緊壓碎 (2次試驗);銳形分離對照夾緊壓碎技術 (1次試驗);噴射式技術對照 CUSA (1次試驗)。其中一個試驗比較CUSA、RFDS、 噴射式技術和夾緊壓碎技術。RFDS組的傳染併發症和切割後的失血量大於夾緊壓碎技術組。 但在輸血需求及加強治療室停留時間 (ITU)或住院日方面沒有顯著差異。其他比較組在死亡率、發病率、肝臟實質損害的指標、肝臟官能障礙、 ITU或住院天數等方面沒有顯著差異。 和CUSA、噴射式技術相比,夾緊壓碎技術的輸血量較低。夾緊壓碎技術和銳形分離技術在輸血要求方面沒有顯著差異。夾緊壓碎技術完成的比CUSA、 噴射式技術、RFDS快。銳形分離的切割速度無法和夾緊壓碎技術相比。 銳形分離和夾緊壓碎技術在手術時間上沒有臨床差異或統計學意義上的顯著差異。,取決與每年實施的手術數量夾緊壓碎技術的價格比其他方法便宜2 – 6倍。

作者結論

人們建議把夾緊壓碎技術作為肝實質切割的方法使用,因為這樣可以避免使用特殊設備,但是這種新方法看似不能在減低發病率或輸血量的方面產生任何的好處。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

夾緊壓碎技術似乎已成為肝實質切除的一種選擇方法:肝臟切除(摘除部分的肝臟)主要針對實施在肝臟中癌變或沒有癌變的腫瘤。每年英國大約有1000例以上的肝臟切除術。肝臟切除過程中的失血量是主要影響出現手術併發症的主因。因此建議使用各種實質切除的方法來減少血液損失。本次系統性文獻回顧了7項隨機試驗,共有556 位病人,比較不同的實質切除技術。射頻切割閉合器(RFDS)的傳染併發症和切割後的血液損失明顯大於夾緊壓碎技術。 其他實質切除技術在死亡率或發病率方面沒有顯著差異。各種方法在肝臟實質損害的標記物或肝臟官能障礙等方面沒有顯著差異。重症治療室停留時間和住院日類似。和CUSA(激光超音波),噴射式技術相比,夾緊壓碎技術的輸血要求較低。夾緊壓碎技術和銳形分離技術在輸血要求方面沒有顯著差異。夾緊壓碎技術完成的比CUSA、噴射式技術、RFDS快。銳形分離的切割速度無法和夾緊壓碎技術相比。銳形分離和夾緊壓碎技術在手術時間上沒有臨床差異或統計學意義上的顯著差異。夾緊壓碎技術的價格比其他方法便宜2 – 6倍,取決與每年實施的手術數量。人們建議把夾緊壓碎技術作為肝實質切割的方法使用, 因為這樣可以避免使用特殊設備,但是這種新方法看似不能在減低發病率或輸血量的方面產生任何的好處。