腹腔镜单极高频电手术在不同组织热效应的研究

The Thermal Effect of Monopolar Electrosurgery on Different Tissues

目的 :研究腹腔镜单极高频电手术在不同作用时间对不同组织造成的热损伤程度 ,探讨针对不同组织所适宜的作用方式。方法 :收集离体大网膜、子宫动脉及子宫肌壁组织标本 ,在相同电流波形、功率 ,不同作用时间下进行电凝或电切 ,在光镜下观察组织形态学改变并测量热坏死带。结果 :①大网膜经电凝后 ,组织坏死带形态不规则 ,其内血管管壁未有效凝固融合。②直径约 1mm的动脉经鼓点式电凝 2次所形成热坏死带最小 ,而凝固融合带最厚。③子宫肌壁经电凝 4秒或 7秒所形成的水平及垂直ZTN宽度分别为 5 4± 0 7mm ,7 4± 0 7mm ,1 9± 0 5mm ,3 4± 0 6mm。结论 :①对大网膜不宜使用电凝或电切。②鼓点式电凝止血方式优于持续电凝止血 ,单纯电切不能达到止血目的。③ 80W功率下 ,子宫肌壁同一部位持续电凝 4秒以内是相对安全的。

Objective:To study the thermal effects of monopolar electrosurgery in laparoscopy on different tissue with different applying time.Methods:Specimens of omentum,uterine artery and uterus were electrocoagulated or electrocut respectively during different applying time in vitro.Histopathological observation and comparison of thermal damage in each tissue were made.Results:①The zone of thermal necrosis(ZTN) of omentum was irregular.The coagulum of blood vessel was very weak.②Intermittent electrocoagulating for 2 times resulted the smallest ZTN,but the most effective coagulum.③The ZTN of uterine wall caused by coagulating 4 or 7 seconds was 5.4±0.7 mm,7.4±0.7 mm,1.9±0.5 mm and 3.4±0.6 mm respectively.Conclusions:①It should be prohibited from applying electrocoagulation or electrocut on omentum.②Intermittent electrocoagulating is better than continous ones for hemostasis except electrocut only.③Continous electrocoagulating on uterine wall lasting for 4 seconds is relatively safety.