LigaSure

摘要： 目的 探讨小钳口 LigaSure在腮腺深浅叶良恶性肿瘤切除术中的应用.方法 前瞻性的纳入西安交通大学第二附属医院耳鼻咽喉头颈外科病院2016年1月—2018年12月行腮腺来源肿瘤接受手术的47例患者,分为利用LigaSure切除(A组)27例及电刀结合传统刀片切除(B组)20例.对两组间的手术时间、术中出血量、术后48 h引流量及术后并发症进行比较.结果 A组的手术时间(85.56±43.94)min与B组(123.00±44.14)min相比,明显缩短(P＜0.05);两组术中出血量[(46.67±42.34)mLvs(75.00±49.92)mL]比较,差异具有统计学意义(P＜0.05);两组术后引流量[(38.15±17.16)mL vs(63.25±21.59)mL]比较,差异有统计学意义(P＜0.05);两组间术后并发症各参数无统计学差异.浅叶切除中A组和B组手术时间[(70.00±17.54)min vs(104.00±25.58)min],术中出血量[(33.81±21.79)mL vs(54.67±19.32)mL]及术后引流量[(32.62±11.36)mL vs(54.33±8.84)mL]比较,差异均具有统计学意义(P均＜0.05).腮腺全切(包括扩大切除)术中使用LigaSure的患者手术时间,术中出血量及术后引流量与对照组比较,差异均无统计学意义(P均＞0.05).结论 小钳口 LigaSure在切除腮腺良恶性肿瘤的应用是安全的,与传统手术方式相比尤其在浅叶手术中LigaSure有出血少,手术时间短等优势.

摘要： 目的 探讨能量器械超声刀、LigaSure血管闭合系统、百克钳与传统缝扎术在经腹宫颈癌手术中的治疗效果.方法 选取我院自2012年12月至2017年12月行腹式宫颈癌手术治疗的患者共209例,分为超声刀组(61例)、LigaSure血管闭合系统组(49例)、百克钳组(45例)、传统缝扎组(54例),比较分析各组相关指标.结果 能量器械组的平均手术时间、切除淋巴结数目、术中出血量均优于传统缝扎组,差异有统计学意义(P0.05).结论 早期宫颈癌患者在行经腹宫颈癌手术中应用能量器械可提高手术的安全性和有效性,具有较高的临床应用价值.

摘要： Anastomotic leak(AL)after low anterior resection(LAR)can be a highly morbid complication.The incidence of AL ranges from 5%to 20%depending on patient characteristics and the distance of the anastomosis from the anal verge.Low anastomoses and leaks pose technical challenges for endoscopic treatment.The aim of this report was to describe the use of a commercially available laparoscopic energy device through a transanal minimally invasive surgery(TAMIS)port for the management of a symptomatic leak not requiring relaparotomy(grade B)after a LAR with diverting loop ileostomy.CASE SUMMARY A TAMIS GelPOINT Path port was inserted into the anus to access the distal rectum.Pneumorectum was achieved with AirSeal insufflation and a 30 degree laparoscope was introduced through a trocar.A LigaSureTM Retractable L-Hook device was then used to perform a septotomy of the chronic sinus tract identified posterior to the coloproctostomy.The procedure was then repeated twice in three weeks intervals with ultimate resolution of the chronic leak cavity.Several months after serial TAMIS septotomies,barium enema demonstrated a patent anastomosis with no evidence of persistent leak or stricture.The patient subsequently underwent ileostomy reversal and has had no significant postoperative issues.CONCLUSION TAMIS septotomy with the LigaSureTM Retractable L-Hook is a feasible and effective,minimally invasive salvage technique for the treatment of grade B ALs.Larger studies are needed to assess the generalizability and long-term results of this technique.

摘要： 目的:评价Ligasure与超声刀两者在开放性近端胃癌根治术中临床疗效差异.方法:对2012年1月-2015年12月在本院施行开放性近端胃癌根治术的66例患者的临床资料进行回顾性分析,其中观察组34例以Ligasure为主要操作器械,对照组32例以超声刀为主要操作器械,比较两组在手术持续时间、术中出血量、淋巴结清扫数量、术后引流液量、住院时间、胃肠道功能恢复时间、术后并发症等方面的差异.结果:观察组手术持续时间为(125.2±26.1)min,显著短于对照组的(156.6±31.5)min(P=0.029);观察组术中出血量为(116.2 ± 38.4)mL,显著少于对照组的(163.8±47.6)mL(P=0.017);两组在淋巴结清扫数量、术后总腹腔引流量、胃肠道功能恢复时间、住院时间等方面差异无统计学意义.结论:Ligasure行开放性近端胃癌根治术安全可行,具有手术时间短、术中出血少的优点.

摘要： Objective Energy based surgical devices such as high frequency electrotome,Harmonic scalpel and LigaSure are widely used in thyroid operations.This study is to demonstrate the difference of tissue thermal damage among different surgical instruments.Methods 12 beagle dogs were randomly divided into 3 groups,electrotome 15 W groups (group A),three-speed Harmonic scalpel (group B) and LigaSure middle gear group (group C).Patients of each group received energy instruments operating on their thyroid tissue which mimics traditional thyroidectomy.The temperatures of gland tissue during procedures were monitored by infrared thermal imager,and the operated thyroid tissues were histologically analyzed.Results The highest temperature was (83.9±8.2)°C in the electrotome group,(70.7±7.5)°C in three-speed Harmonic scalpel group,and (56.6±5.7)°C in LigaSure group.The highest temperature among the three groups was statistically significant.The electrotome (15 W) caused more serious thermal damage to thyroid tissues than that caused by either the Harmonic scalpel or LigaSure (thermal damaged depth:(0.96±0.07) mm vs (0.74±0.07) mm,P＜0.01;(0.96±0.07) mm vs (0.72± 0.11) mm,P＜0.01).Nevertheless,the thermal damage had no significant differences between the Harmonic scalpel and LigaSure group (P=0.845).The thermal damage caused by the 15 W electrotome was significantly larger than that in the other two groups,and the difference had statistical significance (P＜0.01).Conclusion Compared to the high frequency electrotome,Harmonic scalpel and LigaSure lead less tissue thermal damage during thyroid surgeries,owing to less heat production.In that way,Harmonic scalpel and LigaSure are superior to electrotome in terms of safety.%目的 比较电刀、超声刀及LigaSure等能量器械对甲状腺组织的热损伤差异.方法 将12只比格犬分为3组:15 w电刀组、三档超声刀组、中间档LigaSure组,分别以能量器械作用于甲状腺表面组织.作用过程中以红外热成像仪检测组织温度情况,并留取作用后的组织标本观察热损伤深度.结果 15 w电刀作用3s时的最高温度为(83.9±8.2)°C,热损伤深度为(0.96±0.07)mm;3档超声刀激发3s时最高温度为(70.7±7.5)°C,热损伤深度为(0.74±0.07) mm;LigaSure作用时最高温度为(56.6±5.7)°C,热损伤深度为(0.72±0.11)mm.3组间的最高温度比较差异有统计学意义,超声刀与LigaSure的热损伤深度相当,差异无统计学意义(P=0.845).15w电刀产生的热损伤深度较超声刀及LigaSure均明显增大,差异有统计学意义(P＜0.01).结论 LiagSure与超声刀及电刀相比产生的热量更小,LigaSure和超声刀造成的组织热损伤较轻,是甲状腺手术中较为安全的能量器械.

摘要： 目的:探讨Ligasure在对不同大小子宫行开腹全子宫切除术中的应用价值.方法:收治TAH患者174例,按子宫体积大小分3组,A组≤12周(97例),B组13～18周(61例),C组≥20周(16例).每组TAH术中再按是否应用Ligasure血管闭合系统分为两亚组,1组为未使用Ligasure血管闭合系统,2组为使用Ligasure血管闭合系统.回顾性分析3组患者的一般情况、手术时间及术中失血量情况.结果:B1与B2手术时间比较差异有统计学意义(P<0.05).A2、B2、C23组手术时间比较差异有统计学意义(P=0.013),A2与C2、B2与C2比较差异有统计学意义(P<0.05).A2、B2、C23组术中失血量比较差异有统计学意义(P=0.008),A2与C2、B2与C2比较差异有统计学意义(P<0.05).结论:在不同大小子宫的TAH术中,Ligasure的应用价值不一样,并非都能缩短手术时间、减少术中失血量.

摘要： 目的:探讨超声刀及Ligasure在腹腔镜根治性肾根治术处理肾蒂血管中的应用及安全性.方法:选取选取柳州市人民医院2010年1月～2017年12月期间治疗的局限性肾癌(T1N0M0～T2N0M0)患者60例,随机数字表法分为两组,各30例,均采用腹腔镜下均腹膜后入路进行手术,术中处理肾蒂血管时观察组采用Hem-o-Lok夹闭后用超声刀及Ligasure切断,对照组采用采用Hem-o-Lok夹闭后用冷刀切断.统计对比两组手术时间、术中失血量、术后肾窝引流量、住院时间以及手术相关并发症等指标.结果观察组手术时间、住院时间均短于对照组,且术中失血量、术后肾窝引流量均少于对照组,差异有统计学意义(P＜0.05).观察组并发症发生率与对照组比较差异无统计学意义(P＞0.05).结论:证明超声刀及Ligasure对肾脏血管止血满意,治疗效果好,安全性高,费用低廉,值得推广.

摘要： Objective To compare the clinical effects of Ligasure hemorrhoidectomy and traditional hemorrhoidectomy in the treatment of mixed hemorrhoids of grade 3-4 degrees.Methods 120 cases of patients with stage Ⅲ and Ⅳ from January 2014 to June 2015 in Beijing Erlonglu hospital were selected as our subjects and randomly divided into treatment group (LigaSure hemorrhoidectomy,n =60) and control group (conventional hemorrhoidectomy,n =60).The operation time,blood loss,hospitalization time,postoperative pain,bleeding,incision infection and postoperative urinary retention were compared between the two groups.Results There was no significant difference in the operation time between the two groups (P ＞ 0.05).The amount of bleeding and the length of stay in the treatment group were significantly less than those in the control group (P ＜ 0.05).The pain scores of the treatment group after 12 h and first,third,seventh days after operation were significantly lower than those of the control group (P ＜ 0.05).And there were no postoperative bleeding and incision infection in the two groups.There were 5 cases of urinary retention in the treatment group and 6 cases of urinary retention in the control group,the difference was not statistically significant (P ＞ 0.05).Conclusion Compared with traditional hemorrhoidectomy,Ligasure hemorrhoidectomy is more effective in reducing the amount of bleeding and shortening the length of hospital stay.%目的 比较Ligasure痔切除术与传统痔切除术治疗Ⅲ～Ⅳ度混合痔的应用效果.方法 选择2014年1月至2015年6月于北京市二龙路医院收治的120例Ⅲ～Ⅳ度混合痔患者为研究对象,随机分为治疗组(行ligasure痔切除术,n=60)和对照组(行传统痔切除术,n=60).比较两组手术时间、术中出血量、住院时间,术后疼痛、出血、切口感染以及术后尿潴留情况.结果 两组手术时间差异无统计学意义(P＞0.05).治疗组术中出血量、住院时间均显著少于对照组,差异均有统计学意义(均P＜ 0.05).治疗组术后12h、术后第1、3、7d疼痛评分均显著低于对照组,差异均有统计学意义(均P＜0.05).两组术后均无术后出血及切口感染病例.治疗组术后发生尿潴留5例,对照组发生尿潴留6例,差异无统计学意义(P＞0.05).结论 与传统痔切除术相比,Ligasure痔切除术治疗Ⅲ～Ⅳ度混合痔更利于减少术中出血量、缩短住院时间.

摘要： 目的:探讨不同能量器械组合用于腹腔镜下子宫全切术的临床疗效和治疗体会.方法:将100例择期行腹腔镜下子宫全切术(TLH)的患者随机分为观察组和对照组,各50例.观察组患者以Ligasure钳夹配合单极电凝钩辅助进行TLH,切除子宫;对照组患者采用常规的双极电凝单极电沟完成手术,其他操作同观察组.记录手术时间、术中出血量、术后体温恢复时间、肛门排气时间、住院时间,术后记录手术并发症,比较组间差异.结果:①观察组患者手术时间、术后体温恢复时间、肛门排气时间、住院时间明短于对照组,术中出血量大大少于对照组,差异显著(P＜0.05).②观察组患者手术顺利,无中转开腹,术后无严重并发症,2例发热经对症治疗后自行恢复;对照组患者3例中转开腹,2例膀胱壁损伤,1例发热.观察组治疗方案手术更顺利,并发症发生率更低(P＜0.05).结论:Ligasure配合单极电凝钧用于腹腔镜下子宫全切术效果良好,患者恢复更快,并发症低,值得临床推广.

摘要： 本实用新型公开了一种无极触发Ligasure血管闭合切割刀头以及控制开关，无极触发Ligasure血管闭合切割刀头包括第一操作柄、第二操作柄，第一操作柄的中部铰接在第二操作柄的中部，第一操作柄的头端和第二操作柄的头端均固定有刀片，第二操作柄的尾端上设置有用于控制刀片通电状态的控制开关，第一操作柄内设置有用于容纳控制开关的开关腔体，本实用新型无极触发Ligasure血管闭合切割刀头采用无极触发式开关的结构，加长了触发处的开关长度，一旦按压所示开关，便开始激发，进行血管电凝过程，术者可以根据钳夹组织(如肝脏组织)的多少来决定按压的深度，若钳夹的多，便可以进行多次电凝，最后再切割，这样最大限度减少出血与胆漏。

摘要： 本实用新型公开了一种腹腔镜单曲Ligasure刀头，涉及腹腔镜手术用的器具。它包括腹腔镜Ligasure刀头本体，其特征在于，腹腔镜Ligasure刀头本体的前部呈弯曲形状，弯曲处圆弧角为120～150°，刀头端至弯曲点的距离为3-8cm。使用时由于折弯的作用头部有3～8cm半径的活动范围，便于施术者操作。