ligasuretm的临床应用课件

LigaSureTM

的临床应用EnergyBasedTissueandVesselFusionVesselligationisacriticalcomponentofallsurgicaldissection.

血管的结扎是所有外科手术分离中的关键部分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

脉管和组织融合技术ElectrosurgicalTechnologyThatCombinesPressureandEnergy压力和能量ToCreateaFusionZone产生一个融合带TissueandVesselFusionanadvanceinauniqueelectrosurgicaltechnologythatcombinespressureandenergytocreateafusionzone一种先进电外科技术将压力和能量结合从而产生融合带Developedinresponsetosurgeonrequestsforanadditionaloptiontocurrentvesselligationmethods根据外科医生的需求发展的技术，从而提供目前血管结扎手段以外的方法。SystemOperationAppliesoptimalpressuretovessel/tissuebundle在血管/组织束上施加最佳的压力Energydeliverycycle:能量输送周期：Measuresinitialresistanceoftissueandchoosesappropriateenergysettings测量组织的最初电阻并选择适当的能量设定Deliverspulsedenergywithcontinuousfeedbackcontrol

输送能量脉冲同时进行持续的反馈控制Pulsesadaptasthecycleprogresses随循环周期的进行调整能量脉冲Sensesthattissueresponseiscompleteandstopsthecycle监测组织反馈当闭合完成时停止能量输送FusionCharacteristics

融合带的特性Intimallayersofvesselwallsfused融合血管壁的内膜Doesnotrelyonaproximalthrombus不依赖于近端血栓Permanent永久性闭合TissueEffectsofCoagulationVersusVesselFusion

凝血和脉管闭合技术的组织效果的比较Coagulationreliesonvesselshrinkageandaproximalthrombusforvesselocclusion.凝血依赖于血管的收缩和近端血栓堵塞血管Vesselfusionfusestheintimalwallsofthevessel,completelyobliteratingthelumen.脉管闭合技术融合了血管壁的内膜，从而完全封闭管腔。*PorcineModelTissueSelectionCriteria

选择组织的标准Veinsandarteriesuptoandincluding7mm达到并包括7mm的静脉和动脉Tissuebundlescontainingvessel(s)orlymphatics包含有血管或淋巴管的组织束Lymphaticsuptoandincluding7mm达到并包括7mm的淋巴管ResultsHighburststrengthsealsexhibitedthefollowingproperties:高破裂压的闭合带具有以下特性：Thin,translucent,plastic-likesealsite薄的透明弹性闭合带sealzonesignificantlycompressed被压缩的扁平闭合带intimallayersofvesselwallsfused融合血管壁内膜lateralthermaldamage<2mm外侧热损伤<2mmH&EstainedlongitudinalsectionofsealedporcinerenalarteryH&E染色的猪肾动脉闭合带的纵切面Thesealzone.Notethefusedlumenofthevesselwalls.闭合带；注意血管壁已被融合在一起，内腔消失。BurstStrengthStudyResults

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

2-3.9mm4-7mmUltrasonics超声刀Bipolar双极VesselFusion脉管闭合技术VesselsizesHealingprocess

Acomparison*ofthehealingprocessfollowingligationwithsuturesandvesselsealingsystemhavebeenstudiedat7,14and28days.缝线结扎和血管闭合技术的愈合过程中第7、14和28天比较At7days,bothLigaSure™andsuturesitesexhibitedgrosssignsofinflammation.第7天：“LigaSure™和缝线的部位都有炎症的表现…”At14days,numerousadhesionswerenotedatthesuturesiteswhereastheLigaSuresealsdidnotaffectanyofthesurroundingtissue第14天：“在缝线部位有许多的粘连，而LigaSure闭合带与周围组织没有粘连”At28days:

“numerousevolvedadhesionswerepresentatthesuturesites.TheLigaSure™sitesweredifficulttolocate…..”第28天：“缝线部位有许多粘连形成，而LigaSure™闭合部位已经难以确认”Thepotentialforsealscomposedofthepatient’snativetissuereducetheinflammatoryresponseandimproveshealingprocess.闭合带由患者自身的组织构成，从而减少了炎症反应，促进了愈合过程。*ComparisonofHealingProcessFollowingLigationwithSuturesandBipolarVesselSealingPETERSON,STRANAHAN,SCHMALTZ,MIHAICHUK,COSGRIFFSurgicalTechnologyInternationalSuturesat28daysLigaSureat28daysVesselFusionTechnologyEnsures:Fusionstrengthshigherthanotherenergybasedtechniques闭合强度高于其他的能量技术Fusionstrengthscomparabletoexistingmechanicalbasedtechniques闭合强度与现存的机械闭合技术相当VesselFusionTechnologyEnsures:Reliable,consistent,permanentvesselwallfusion可靠的、一致的、永久性血管壁融合Minimalthermalspread最小的热传导Reducedstickingandcharring较少的粘连和焦痂SurgicalspecialtieswithexperienceinvesselfusiontechnologySurgicalApplicationsGeneralSurgeryGastrectomy胃切除术Gastrojejunostomy胃空肠吻合术GastricBypass胃旁路手术Mastectomy乳房切除术AxillaryDissection腋窝淋巴结清扫LiverResection肝切除LivingDoorLiverTransplant活体肝移植手术Splenectomy脾切除术Thyroidectomy甲状腺切除术LapNissen腔镜Nissen手术Esophagectomy食道切除术BowelResection小肠切除术AbdominalPerinealResection经腹会阴联合切除术LowAnteriorResection低位前切除Colectomy结肠切除术Hemorrhoidectomy痔切除术Whipple胰十二指肠切除术Omentectomy网膜切除术Ileo-analPull-through拖出式回肠肛管吻合术RectalProlapse直肠脱垂手术Adrenalectomy肾上腺切除术LapColectomy腔镜结肠切除术Gynaecology

妇产科腹腔镜子宫切除术Studyby:BarbaraLevy,MD

ClinicalAssistantProfessorof

OB/GYN,UofWASeattle,WASealableNotrecommendedVaginalHysterectomy

经阴道的子宫切除术84patients共84例患者Bloodlossdecreasedinallcasescomparedtoaverageexpectedloss所有病例的失血量均少于平均预期失血量5casessutureusedononeside,vesselfusionusedontheother5例在一侧使用缝线，另一侧使用脉管闭合技术Operativetimeconsistentlydecreased

10-20minutes手术时间平均下降10～20minStudyby:RobertMcLellan,MDDepartmentofGynecologyLaheyClinic,Burlington,MATotalAbdominalHysterectomy50patients(randomizedvesselfusion/suture)50例患者（随机使用血管闭合技术/缝线）Proceduretime(abdominalincisiontoclosureofvaginalcuffwithsatisfactoryhemostasis手术时间（从做腹部切口到关闭阴道袖并得到满意的止血效果）Vesselfusion30.6min.(18-62)使用血管闭合技术：30.6min(18~62)Suture48.2min.(30-109)使用缝线：48.2min(30~109)Bloodloss失血量Vesselfusion–32-50ccSuture–25-250ccSealableNotrecommended结肠解剖ColonAnatomy结肠的解剖RightHemicolectomy右半结肠切除术TransverseColectomy横结肠切除术LeftColectomy左半结肠切除术SigmoidColectomy乙状结肠切除术LowAnteriorResection低位前切除LaparoscopicAssistedColectomy

腔镜辅助的结肠切除术IndicationsColoncarcinoma结肠癌Rectosigmoidcancers直乙结肠癌 Rectalcancer直肠癌Benigncolonpolyps良性结肠息肉Diverticulitis憩室Volvulus肠扭转Crohn'sdiseaseofthebowel克隆氏病Squamouscellcarcinomaoftheanus肛管鳞状上皮细胞癌Analorrectalsarcomas肛门或直肠肉瘤Crohn'sdiseaseof