高频电刀对腹部切口愈合影响的实验和临床研究

Influence of high-frequency electric surgical knife on healing of abdominal incision, experimental and clinical studies

目的 探讨高频电刀对腹部切口愈合的影响。方法 将 2 4 0只大鼠平均分成实验组和对照组 2组 ,分别用电刀和普通手术刀制成腹部手术的动物模型 ,用生理盐水 (10°) ,以及 10 2 、10 5和10 8浓度的大肠埃希氏杆菌、金黄色葡萄球菌和铜绿假单胞菌的定量混合液 0 .2ml分别注入皮下 ,以观察电刀和冷刀在不同浓度细菌存在的条件下对切口感染的影响。在动物实验的基础上 ,随机将2 2 0例腹部Ⅱ类以上手术的患者分为电刀组 (93例 )、电凝组 (5 5例 )、对照组 (72例 )。其中 ,电刀组剖腹时用高频电刀切割组织 ,并用电凝止血。电凝组用普通手术刀剖腹 ,用电凝止血。对照组用普通手术刀剖腹 ,用丝线打结止血。观察 3组患者术后切口愈合的情况。结果 实验显示除 10 0 组外 ,其他各组使用电刀的切口感染率明显高于对照组。经统计学处理 ,10 2 组、10 5组和 10 8组的差异均有显著意义 (P <0 .0 5 ) ,10 0 组的差异无显著意义 (P >0 .0 5 )。临床观察发现 ,电刀组有 16例 (17.2 0 % ) ,电凝组有 9例 (16 .36 % ) ,而对照组 2例 (2 .86 % )切口愈合延迟。电刀组与对照组的差异有非常显著意义(χ2 =8.5 7,P <0 .0 1) ,电凝组与对照组的差异有显著意义 (χ2 =5 .6 6 ,P <0 .0 5 ) ,电刀和电凝组的差异无显著意义 (χ2

Objective To study the influence of high frequency electric surgical knife on abdominal incision healing. Methods Two hundred and forty Wistar rats were randomly divided into two groups of 120 rats to undergo abdominal incision by high frequency electric knife or common lancet respectively. Each of these two groups was redivided into four subgroups that were injected hypodermically with 0.2 ml of quantitative mixture of Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa at the concentrations of 0.24×10 2 bacteria (10 2 group), 4.49×10 4 bacteria (10 5 group), and 4.11×10 7 bacteria (10 8 group) respectively, and normal saline of the same volume (10 0 group). Eight days after the operation, the rats were killed. The infection rate of the operational wound was observed and the tissues around the wounds were examined pathologically. On the basis of the animal experiment, 220 patients undergoing abdominal operation above type Ⅱ were randomly allocated into one of following three groups: high frequency electric knife (EK) group (93 cases, high frequency electric knife was used to cut the abdominal tissues and electro coagulation was used for hemostasis), electro coagulation (EC) group (55 cases, the abdominal tissues were cut witth common lancet and electro coagulation was used for hemostasis) and control group (72 cases, common lancet and silk thread suture were used). The healing of wound was observed after operation. Results Four rats died of anesthetic accident; the other 236 rats were killed 8 days after. The wound infection rates were 23.33% and 6.60% in the experimenal 10 0 group and the control 10 0 group respectively (χ 2=3.28, P>0.05); 37.04% and 13.33% in the experimenal 10 2 group and the control 10 2 group respectively (χ 2=4.31, P >0.05), 50.00% and 24.14% in the experimenal 10 5 group and the control 10 5 group respectively (χ 2=4.22, P >0.05); and 63.33% and 36.67% in the experimenal 10 8 group and the control 10 8 group respectively (χ 2=4.27, P >0.05). Clinical observation showed a delayed wound healing rateof 17.20% (16 cases) in EK group, 16.36% (11 cases) in EC group, and 2.86% (2 cases) in the control group. There was a statistically significant difference in delayed wound healing rate between the EK and control groups (χ 2=8.57, P <0.01) and between the EC and control groups(χ 2=5.66, P <0.05). However, no significant difference in the delayed wound healing rate was seen between the EK and EC groups (χ 2=0.017, P >0.05). Conclusion High frequency electric knife remarkably delays the healing of abdominal incision. Its application should be minimized so as to reduce the possibility of postoperative complications.