腹腔镜手术超声止血刀与电刀封合血管的对比实验研究

EXPERIMENTAL STUDY OF THE ULTRASONICALLY ACTIVATED SCALPEL AND ELECTROME TO SEAL BLOOD VESSEL

目的 :探讨超声止血刀和电刀封合血管的安全范围。方法 :将犬的四肢、腹部以及颈部不同管径的血管游离出体外 ,采用超声止血刀、双极电刀以及单极电刀进行无张力血管封合 ,使其管腔内压力逐渐升至30 0mmHg ,观察 :封合端破裂 ;血管壁非封合端破裂 ;管腔内达到预期压力 30 0mmHg。结果 :超声止血刀封合不同管径的血管时 ,除腹主动脉封合端发生 3次破裂外 ,其余动、静脉封合端皆能抑制 30 0mmHg压力 ;双极电刀凝固血管除下腔静脉凝固端发生全部破裂外 ,其余动、静脉凝固端皆能抑制管腔内 30 0mmHg压力。单极电刀对动脉直径≤ 2 .5mm和静脉直径≤ 2mm是安全可靠的 ;三者皆无血管壁破裂。结论 :超声止血刀对直径≤ 9mm的动脉以及直径≤ 10mm的静脉 ,双极电刀对直径≤ 9mm的动脉和直径≤ 7mm的静脉以及单极电刀对直径≤ 2 .5mm的动脉和直径≤ 2mm的静脉的封合 ,其封合端皆能够抵制管腔内 30 0mmHg的压力。

Objective:To analyze the margin of safety by ultrasonically activated scalpel and electrome in sealing blood vascular. Method:In an anesthetized living dog,segments of the artery and vein separated from the four limbs,abdominal,and cervical vessels were sealed by ultrasonically activated scalpel,Ligasuge TM vessel sealing system or monopolar electrome at either end of the vessel.The intraluminal pressure of the sealed segments was increased until ①the sealed end burst,②the vessel wall burst,or ③ the predetermined pressure (300mmHg) was obtained.Results:In none of the cases did the vessel wall burst when the predetermined pressure was obtained.The sealed end was not ruptured by ultrasonically activated scalpel except for aorta abdominalis at an intraluminal pressure of up to 300mmHg.The sealed end was not ruptued by LigaSuge TM vessel sealing system except for inferior vena cava at the predetermined pressure.There was the margin of safety by monopolar electrome. Conclusions:It is safe and effective to use ultrasonically activated scalpel in sealing artery(diameter≤9mm) and vein (diameter≤10mm),use LigaSuge TM vessel sealing system in sealing artery (diameter≤9mm)and vein (diameter≤7mm) and to use monopolar electrome in sealing artery (diameter≤2.5mm) and vein (diameter≤2mm) when subjected to an intraluminal pressure of up to 300mmHg.