ligasuretm的临床应用课件.pptVIP

* Fifty patients undergoing TAH were randomized to either vessel fusion or sutures as the hemostasis technique. Procedure time was defined as time from abdominal incision to closure of the vaginal cuff with satisfactory hemostasis.  Blood loss was estimated by the anesthesia service.  Required Statement prior to discussing blood loss or operative time: In this study, Dr. McLellan reported: Procedure time was significantly less in the vessel fusion arm, 30.6 minutes (range: 18min-62min) versus 48.2 minutes (range: 30min-109min) in the suture arm (p0.001). Blood loss was significantly less in the vessel fusion arm with an average of 74.2 cc (range: 32cc-50cc) versus 118.7 cc (range: 25cc-250cc) in the suture arm (p=0.02). R. McLellan, MD, C. Anania, MD, M.Birdsall, MD, et. al. (2001). LigaSure? versus sutures in total abdominal hysterectomy. Abstract for ACOG, 2001. 结肠解剖 Colon Anatomy 结肠的解剖 Right Hemicolectomy 右半结肠切除术 Transverse Colectomy 横结肠切除术 Left Colectomy 左半结肠切除术 Sigmoid Colectomy 乙状结肠切除术 Low Anterior Resection 低位前切除 Laparoscopic Assisted Colectomy腔镜辅助的结肠切除术 Indications Colon carcinoma 结肠癌 Rectosigmoid cancers 直乙结肠癌 Rectal cancer 直肠癌 Benign colon polyps 良性结肠息肉 Diverticulitis 憩室 Volvulus 肠扭转 Crohns disease of the bowel 克隆氏病 Squamous cell carcinoma of the anus 肛管鳞状上皮细胞癌 Anal or rectal sarcomas 肛门或直肠肉瘤 Crohns disease of the rectum 直肠克隆氏病 Anal or rectal melanoma 肛门或直肠黑色素瘤 Laparoscopic Surgery Less pain 较少的疼痛 Faster recovery 更快的恢复 Earlier discharge 住院时间短 Earlier return to work 更快的恢复工作 ?Better survival from cancer ？肿瘤患者的生存率更高 MASSIVE PATIENT DEMAND Down Sides of Laparoscopy More difficult 操作更困难 Learning curve (20-30 cases) 学习曲线（20～30例） Longer operating time, initially 更长的手术时间（最开始时） Technology dependant 依赖于医生的技术 Contraindications禁忌症 Inadequately trained surgeon / surgical team 未经充分训练的外科医生/手术组 Large, locally advanced cancers 大的局部进展期肿瘤 Multiple previous surgeries 多次手术史