双极电凝、LigaSure及超声刀对人子宫旁血管组织热损伤的实验研究

Experimental Study on Thermal Effects of Human Uterine Vascular Tissues by Bipolar Electrocoagulation,LigaSure and Ultrasound Knife

目的探讨腹腔镜下全子宫切除术(total laparoscopic hysterectomy,TLH)中双极电凝、Liga Sure及超声刀对人子宫旁血管组织的热损伤程度,指导TLH术中合理选择电外科器械。方法对拟行TLH患者截取分别以双极电凝、Liga Sure及超声刀处理的子宫旁血管组织各30块,共计90块,显微镜下测量电凝部位热损伤宽度。结果 3种电外科器械对子宫旁血管组织热损伤程度不同,热损伤宽度双极电凝组(4.583±0.538)mm,明显大于Liga Sure组(4.207±0.525)mm(q=3.654,P<0.05)和超声刀组(3.506±0.623)mm(q=10.465,P<0.05),Liga Sure组热损伤宽度明显大于超声刀组(q=6.812,P<0.05)。结论双极电凝对人子宫旁血管组织的热损伤宽度最大,Liga Sure次之,超声刀最小,TLH术中处理子宫血管时要根据实际情况,合理选择电器械,避免副损伤。

Objective To study the thermal damage of uterine vascular tissues by bipolar electrocoagulation,Liga Sure and ultrasound knife in total laparoscopic hysterectomy（ TLH）,and to guide the selection of electeosurgery equipments in TLH.Methods TLH was carried out in patients with myoma of uterus,adenomyosis and dysfunctional uterine bleeding. A total of 90 uterine vascular tissues were studied, including 30 tissues receiving bipolar electrocoagulation,30 tissues receiving Liga Sure electrocoagulation and 30 tissues receiving ultrasound knife dessection. The differences of the thermal damage width of uterine vascular tissues were detected. Results The thermal damage width with bipolar electrocoagulation [（ 4. 583 ± 0. 538） mm] was significantly greater than the Liga Sure electrocoagulation [（ 4. 207 ± 0. 525） mm,q = 3. 654,P〈0. 05] and the ultrasound knife [（ 3. 506 ±0. 623） mm,q = 10. 465,P〈0. 05]. The thermal damage width with the Liga Sure electrocoagulation was significantly greater than the ultrasound knife（ q = 6. 812,P〈0. 05）. Conclusions Bipolar electrocoagulation has the greatest thermal damage width,followed by Liga Sure electrocoagulation and ultrasound knife. It is necessary to choose laparoscopic electrosurgical instruments reasonably to avoid side-injury during performance of uterine vessels in TLH.