ligasuretm的臨床應(yīng)用課件

LigaSureTM

的臨床應(yīng)用EnergyBasedTissueandVesselFusionVesselligationisacriticalcomponentofallsurgicaldissection.

血管的結(jié)扎是所有外科手術(shù)分離中的關(guān)鍵部分LigationTechniquesManufacturer'sRecommendedRangeofVesselSizeforApplication(mm)0.51.01.52.02.53.03.54.04.55.05.56.06.57.07.58.08.59.09.510.0Suture

Clips

Staples

MonopolarES

BipolarES

UltrasonicCoag

VesselSealing

**3sizesofclipsandappliersVascularStaples

VesselandTissueFusion

脈管和組織融合技術(shù)ElectrosurgicalTechnologyThatCombinesPressureandEnergy壓力和能量ToCreateaFusionZone產(chǎn)生一個(gè)融合帶TissueandVesselFusionanadvanceinauniqueelectrosurgicaltechnologythatcombinespressureandenergytocreateafusionzone一種先進(jìn)電外科技術(shù)將壓力和能量結(jié)合從而產(chǎn)生融合帶Developedinresponsetosurgeonrequestsforanadditionaloptiontocurrentvesselligationmethods根據(jù)外科醫(yī)生的需求發(fā)展的技術(shù)，從而提供目前血管結(jié)扎手段以外的方法。SystemOperationAppliesoptimalpressuretovessel/tissuebundle在血管/組織束上施加最佳的壓力Energydeliverycycle:能量輸送周期：Measuresinitialresistanceoftissueandchoosesappropriateenergysettings測量組織的最初電阻并選擇適當(dāng)?shù)哪芰吭O(shè)定Deliverspulsedenergywithcontinuousfeedbackcontrol

輸送能量脈沖同時(shí)進(jìn)行持續(xù)的反饋控制Pulsesadaptasthecycleprogresses隨循環(huán)周期的進(jìn)行調(diào)整能量脈沖Sensesthattissueresponseiscompleteandstopsthecycle監(jiān)測組織反饋當(dāng)閉合完成時(shí)停止能量輸送FusionCharacteristics

融合帶的特性Intimallayersofvesselwallsfused融合血管壁的內(nèi)膜Doesnotrelyonaproximalthrombus不依賴于近端血栓Permanent永久性閉合TissueEffectsofCoagulationVersusVesselFusion

凝血和脈管閉合技術(shù)的組織效果的比較Coagulationreliesonvesselshrinkageandaproximalthrombusforvesselocclusion.凝血依賴于血管的收縮和近端血栓堵塞血管Vesselfusionfusestheintimalwallsofthevessel,completelyobliteratingthelumen.脈管閉合技術(shù)融合了血管壁的內(nèi)膜，從而完全封閉管腔。*PorcineModelTissueSelectionCriteria

選擇組織的標(biāo)準(zhǔn)Veinsandarteriesuptoandincluding7mm達(dá)到并包括7mm的靜脈和動(dòng)脈Tissuebundlescontainingvessel(s)orlymphatics包含有血管或淋巴管的組織束Lymphaticsuptoandincluding7mm達(dá)到并包括7mm的淋巴管ResultsHighburststrengthsealsexhibitedthefollowingproperties:高破裂壓的閉合帶具有以下特性：Thin,translucent,plastic-likesealsite薄的透明彈性閉合帶sealzonesignificantlycompressed被壓縮的扁平閉合帶intimallayersofvesselwallsfused融合血管壁內(nèi)膜lateralthermaldamage<2mm外側(cè)熱損傷<2mmH&EstainedlongitudinalsectionofsealedporcinerenalarteryH&E染色的豬腎動(dòng)脈閉合帶的縱切面Thesealzone.Notethefusedlumenofthevesselwalls.閉合帶；注意血管壁已被融合在一起，內(nèi)腔消失。BurstStrengthStudyResults

Percentsuccessoffusionzonewithstanding3timesnormalsystolicpressure(360mmHg)0%20%40%60%80%100%1.0-1.9mm

2-3.9mm4-7mmUltrasonics超聲刀Bipolar雙極VesselFusion脈管閉合技術(shù)VesselsizesHealingprocess

Acomparison*ofthehealingprocessfollowingligationwithsuturesandvesselsealingsystemhavebeenstudiedat7,14and28days.縫線結(jié)扎和血管閉合技術(shù)的愈合過程中第7、14和28天比較At7days,bothLigaSure?andsuturesitesexhibitedgrosssignsofinflammation.第7天：“LigaSure?和縫線的部位都有炎癥的表現(xiàn)…”At14days,numerousadhesionswerenotedatthesuturesiteswhereastheLigaSuresealsdidnotaffectanyofthesurroundingtissue第14天：“在縫線部位有許多的粘連，而LigaSure閉合帶與周圍組織沒有粘連”At28days:

“numerousevolvedadhesionswerepresentatthesuturesites.TheLigaSure?sitesweredifficulttolocate…..”第28天：“縫線部位有許多粘連形成，而LigaSure?閉合部位已經(jīng)難以確認(rèn)”Thepotentialforsealscomposedofthepatient’snativetissuereducetheinflammatoryresponseandimproveshealingprocess.閉合帶由患者自身的組織構(gòu)成，從而減少了炎癥反應(yīng)，促進(jìn)了愈合過程。*ComparisonofHealingProcessFollowingLigationwithSuturesandBipolarVesselSealingPETERSON,STRANAHAN,SCHMALTZ,MIHAICHUK,COSGRIFFSurgicalTechnologyInternationalSuturesat28daysLigaSureat28daysVesselFusionTechnologyEnsures:Fusionstrengthshigherthanotherenergybasedtechniques閉合強(qiáng)度高于其他的能量技術(shù)Fusionstrengthscomparabletoexistingmechanicalbasedtechniques閉合強(qiáng)度與現(xiàn)存的機(jī)械閉合技術(shù)相當(dāng)VesselFusionTechnologyEnsures:Reliable,consistent,permanentvesselwallfusion可靠的、一致的、永久性血管壁融合Minimalthermalspread最小的熱傳導(dǎo)Reducedstickingandcharring較少的粘連和焦痂SurgicalspecialtieswithexperienceinvesselfusiontechnologySurgicalApplicationsGeneralSurgeryGastrectomy胃切除術(shù)Gastrojejunostomy胃空腸吻合術(shù)GastricBypass胃旁路手術(shù)Mastectomy乳房切除術(shù)AxillaryDissection腋窩淋巴結(jié)清掃LiverResection肝切除LivingDoorLiverTransplant活體肝移植手術(shù)Splenectomy脾切除術(shù)Thyroidectomy甲狀腺切除術(shù)LapNissen腔鏡Nissen手術(shù)Esophagectomy食道切除術(shù)BowelResection小腸切除術(shù)AbdominalPerinealResection經(jīng)腹會陰聯(lián)合切除術(shù)LowAnteriorResection低位前切除Colectomy結(jié)腸切除術(shù)Hemorrhoidectomy痔切除術(shù)Whipple胰十二指腸切除術(shù)Omentectomy網(wǎng)膜切除術(shù)Ileo-analPull-through拖出式回腸肛管吻合術(shù)RectalProlapse直腸脫垂手術(shù)Adrenalectomy腎上腺切除術(shù)LapColectomy腔鏡結(jié)腸切除術(shù)Gynaecology

婦產(chǎn)科腹腔鏡子宮切除術(shù)Studyby:BarbaraLevy,MD

ClinicalAssistantProfessorof

OB/GYN,UofWASeattle,WASealableNotrecommendedVaginalHysterectomy

經(jīng)陰道的子宮切除術(shù)84patients共84例患者Bloodlossdecreasedinallcasescomparedtoaverageexpectedloss所有病例的失血量均少于平均預(yù)期失血量5casessutureusedononeside,vesselfusionusedontheother5例在一側(cè)使用縫線，另一側(cè)使用脈管閉合技術(shù)Operativetimeconsistentlydecreased

10-20minutes手術(shù)時(shí)間平均下降10～20minStudyby:RobertMcLellan,MDDepartmentofGynecologyLaheyClinic,Burlington,MATotalAbdominalHysterectomy50patients(randomizedvesselfusion/suture)50例患者（隨機(jī)使用血管閉合技術(shù)/縫線）Proceduretime(abdominalincisiontoclosureofvaginalcuffwithsatisfactoryhemostasis手術(shù)時(shí)間（從做腹部切口到關(guān)閉陰道袖并得到滿意的止血效果）Vesselfusion30.6min.(18-62)使用血管閉合技術(shù)：30.6min(18~62)Suture48.2min.(30-109)使用縫線：48.2min(30~109)Bloodloss失血量Vesselfusion–32-50ccSuture–25-250ccSealableNotrecommended結(jié)腸解剖ColonAnatomy結(jié)腸的解剖RightHemicolectomy右半結(jié)腸切除術(shù)TransverseColectomy橫結(jié)腸切除術(shù)LeftColectomy左半結(jié)腸切除術(shù)SigmoidColectomy乙狀結(jié)腸切除術(shù)LowAnteriorResection低位前切除LaparoscopicAssistedColectomy

腔鏡輔助的結(jié)腸切除術(shù)IndicationsColoncarcinoma結(jié)腸癌Rectosigmoidcancers直乙結(jié)腸癌 Rectalcancer直腸癌Benigncolonpolyps良性結(jié)腸息肉Diverticulitis憩室Volvulus腸扭轉(zhuǎn)Crohn'sdiseaseofthebowel克隆氏病Squamouscellcarcinomaoftheanus肛管鱗狀上皮細(xì)胞癌Analorrectalsarcomas肛門或直腸肉瘤Crohn'sdiseaseof