多种腹腔镜电凝器械对卵巢组织热损伤的研究

Evaluation of Heat Damage on Ovarian Tissue by Laparoscopic Electrocoagulation Instruments

目的:研究腹腔镜手术中单极电凝、双极电凝、等离子电切刀(PK刀)和结扎速血管闭合钳(LigaSure)对卵巢组织的热损伤效应,以助于临床合理选择电外科手术器械。方法:取手术中切除的人类正常卵巢组织,分别用上述电外科器械电凝,然后将组织块包埋、切片,HE染色后在光学显微镜下观察,并测量热损伤的宽度和深度。结果:电凝后卵巢组织均有不同程度的凝固性坏死,4种器械的热损伤坏死带范围宽度和深度之间比较,差异均有高度统计学意义(P=0.000)。其中两两比较中,LigaSure组的热损伤坏死深度小于单极电凝组(P=0.044),PK刀组的热损伤坏死宽度小于LigaSure组(P=0.002)、单极电凝组(P=0.024)和双极电凝组(P=0.045)。结论:各种腹腔镜电凝止血均会对卵巢组织造成一定的热损伤,在行腹腔镜卵巢手术时,应尽量减少电凝止血的操作,并尽量选用热损伤范围小的智能双极系统如PK刀等。

Objective：To evaluate the heat damage by laparoscopic Monopolar coagulation, bipolar coagulation,PlasmaKinetics,and LigaSure to ovarian tissue, so as to help surgeons to make a better choice on electrocoagulation instruments in operation. Methods：The normal human ovarian tissue coming from oophorotomy was electrocoagulate by different kinds of instruments. The damaged ovarian tissue was embedded, HE stained,and observed under the optical microscope. Also,the width and depth of thermal damage were measured. Results：Ovarian tissue after coagulation showed different degrees of coagulative necrosis. The depth and width of Heat damage by 4 different instruments were statistically different （ P =0.000）. The depth of heat damage by LigaSure was smaller than that by monopolar coagulation （ P = 0.044）. The width of heat damage by PlasmaKinetic was smaller than that by LigaSure （ P = 0.002）, by monopolar coagulation （ P = 0.024） and by bipolar coagulation （ P = 0.045）. Conclusions： Laparoscopic electrocoagulation can cause different degrees of ovarian tissue damage, PlasmaKinetic is a better choice when electrocoagulation is necessary in ovary surgery.