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

1、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 v

2、arious 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 techn

3、ique should be considered an important factor in preventing intra operative and post operative compliications.
　　Aim:The aim ofthis randomized clinical trial was to compare and measure the efficacy of EBVS+CUSA with t

4、raditional 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 bi

5、le leak and related complications.
　　Objectives:To Analyze and evaluate, the effectiveness and performance of the Two-Surgeontechnique using CUSA+EBVS with the conventional Classic crushing clampCCC for hepatectomies

6、done in cirrhotic and non cirrhotic patients. ThisProspective randomized study was done to conduct the end points as blood-loss,auration of surgery ICU stav, livermnctions before/after the surgery, postoperative infectio

7、n and hospital stay.
　　Methods:From the period of 2010 t0 2012, total of 60 randomized clinical patientsunderwent the procedure for hepatectomy. Patients were divided into two groupsaccording to the device used for he

8、patectomy. Patienis underwent classic crushingclamp technique (CCC) was assigned to Group A (n=30) and patients who underwent two surgeons technique using cavitron ultrasonic aspirator plus electrothermal bipolar vesse

9、l 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 were 54.20±14.33years in Group A and 49.27±8.44years in Group B. Ov

10、erall 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=0.02

11、3) were markedly less than those in group A (788.67±732.59ml, p=0.007 and 636.67±767.66ml, p=0.023 respectively). The mean hospitalization time and ICU stay of Group B (15.7±4.252d and 314.33±373.026min.) was markedly

12、reduced than that of Group A (20.8d±8.475d and 736.73±853.029min. P=0.005 and p=0.012 respectively). There was No significant differences observed in ALT changes before and after the surgery, Child Pugh score, ascites,

13、 infection, bile leakage, cirrhosis, age or gender
　　CONCLUSION:After the analysis it is concluded that two-surgeon technique using CUSA+EBVS compared with CCC, could evidently reduce the operative injury, intra opera

14、tive 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