The use of an electrosurgical unit "LigaSure" for colorectal cancer metastases to the liver
Science Articles / / April 22, 2016
Vyskubov VN Turutin AD, Igumenov AV, Christmas AI Slobodkin AY
Common forms of colorectal cancer in recent years, is one of the most urgent and difficult problems in Coloproctology.With the increasing number of patients with diseases onkoproktologicheskimi increases and the frequency of distant metastases in different liver segments.
Virtually every third cancer patients, regardless of the primary tumor, detected in liver metastases.Synchronous and metachronous liver metastases are detected in 14-40% of patients who underwent resection of the colon for cancer.The average life expectancy of patients with untreated metastases is 2-6 months.
main method to achieve long-term survival with metastases to the liver, it is resected.Radical surgery is possible to produce in 5-15% of cases, in other cases, the treatment of metastases is only possible with the use of different chemotherapy options or perform a variety of palliative surgery - cryotherapy, transhepatic alcoholism, radiofrequency ablation.
purpose of the study - assessment of the effectiveness of electrosurgical apparatus Liga Sure in improving the immediate and long-term results of treatment of patients with colorectal cancer with liver metastases
Methods and materials research. This report analyzes 7 histories of persons who were operated in 2003 on the occasion of the presence of colorectal cancer with liver metastases.The age of patients ranged from 45 to 65 years.9 Liver resections performed within 2.3 - 5 and 6 segments.All interventions within these segments we have identified a group of "thrifty" liver resections.
use generators for elektroligirovaniya Liga Sure, in the heart of the action which is the denaturation of collagen and elastin in conjunction with a controlled supply of energy and dosed compression on blood vessels.Apparatus vessels securely welds to 5 mm in diameter and hermetically welds "solders" bile ducts.At the edge of the liver resection by this method the top of the triangle opposite the edge of the liver should be directed to the "center" of the liver, to the vascular pedicle removed secretory segment or subsegment of the liver.
Marginal liver resection is performed according to the classical method.Liver parenchyma excised triangle without flashing ginglymoid hemostatic sutures.Pre impose clamp connected to the machine Liga Sure liver edge to sosudistosekretornoy leg.Branche Closure device and the current supply to the working surfaces simultaneously.Branche device easily and dispensed crushed and coagulated parenchyma of liver tissue (original elektroklaziya).Ganging clamp jaws snap lock on the tubular structures, and then there is their reliable brewing.The removable portion of the liver parenchyma is cut with scissors to a length Branche machine, leaving a scab on the liver after exposure to electric current.The clamp is applied to the next section of parenchymal resection lines and the whole operation is repeated.Two resection lines occur in the expected vascular secretory feet in the "thick" a place to stay the liver parenchyma.
we describe a technique in 5 patients allowed to perform the removal of single liver metastasis and 2 patients, at the same time receiving electrosurgical resection, enucleation performed by one metastatic site with diaphragmatic surface of the liver using electrocautery for hemostasis.We have not observed complications such as blood or bile leakage in the postoperative period, but always drained area of liver resections silicone tubing.
Thus, a preliminary analysis leads to the conclusion that the use of electrosurgical apparatus Liga Sure combines the advantages of simplicity and security with better postoperative period.Further improvement techniques sparing dissection of tissues, coupled with reliable hemostasis and the knowledge of the hidden side of the apparatus allows to expand the indications for surgery of liver resection with the edge of her metastatic lesions.