肝实质离断技术的选择与评价

Evaluation and selection of various techniques of liver parenchymal transection

在肝脏外科的发展过程中，肝实质离断技术经历过许多演变。传统的技术有指折法和钳夹法。近年来新的肝实质离断技术和器械不断涌现。这些技术都基于同一个目的：快速肝实质离断、将失血量降至最少及封闭胆管以避免术后发生胆汁漏。不同的肝实质离断技术各有其优缺点。这些技术的具体使用则取决于患者的一般情况、术者的经验以及单位的条件。本文旨在讨论及比较各种肝实质的离断技术。

Various techniques of liver pareuchymal transection have been introduced, including the finger fracture technique, clamp-crush method, Cavitron ultrasonic surgical aspirator, waterjet, TissueLink, Ligasure, harmonic scalpel, vascular stapler, radiofrequency dissection sealer and the Peng＇s muhifunction operative dissector. All these techniques have the common goals of achieving rapid liver parenchymal transection, minimizing blood loss and preventing bile leak or fistula. It is still unclear which technique is the best. The technique of choice for any individual surgeon would depend on the condition of patients, surgeon＇s experience and the resources available. This article reviewed the current development and role of the various techniques.