腹腔镜手术烟雾净化器的制作与应用

Production and application of the laparoscopic surgical smoke purifier

目的 设计一款腹腔镜手术烟雾净化器，测试其在减少CO2 气体使用量和降低腹腔镜手术烟雾中有害物质浓度方面的应用效果。方法 收集2017 年4—9 月进行腹腔镜下全子宫切除加双附件切除加盆腔淋巴结清扫手术患者共136 例，采用随机数字表法分为对照组和观察组，每组 68 例。对照组使用独立的负压吸引管路直接吸除手术烟雾。观察组手术烟雾首先通过腹腔镜手术烟雾净化器，该净化器进气管路由无菌输血器改造而成，气体通过双瓣式单向阀时会发出声音提醒，烟雾依次通过KP100 等级、KN100 等级的过滤元件及一定量的防护用煤质柱状颗粒活性炭后，使用独立的负压吸引管路吸除。记录两组手术CO2 气体使用量，比较观察组手术烟雾中有害物质在净化前后的浓度。结果 对照组手术CO2 使用量为（656.95±70.11）L，高于观察组的（613.70±75.63）L，差异具有统计学意义（P ＜ 0.01）。观察组使用净化器前PM10（206.90±30.48）μg/m3、PM2.5（195.74±27.23）μg/m3、 PM1.0（220.22±37.60）μg/m3、甲醛（0.52±0.02） mg/m3、总有机挥发物（ 4.35±1.79） mg/m3，浓度均大于使用净化器后的PM10（4.26±1.02）μg/m3、PM2.5（6.54±2.05） μg/m3、PM1.0（7.89±3.38） μg/m3、甲醛（0.34± 0.01） mg/m3、总有机挥发物（ 0.31±0.17） mg/m3，差异均有统计学意义（P＜0.01）。结论 研制的净化器能降低腹腔镜手术中CO2气体使用量，降低手术烟雾中有害物质含量，减少对环境和医务人员的危害。

Objective To design a smoke purifier for laparoscopic surgery, and to test its application in reducing the use of carbon dioxide gas and reducing the concentration of harmful substances in laparoscopic surgery exhaust gas. Methods From April to September 2017, a total of 136 cases of hysterectomy and bilateral salpingo oophorectomy and pelvic lymph node dissection were divided into control group and experimental group by random number table method, with 68 cases in each group. Independent negative pressure suction pipeline was applied in the control group for direct suction. In the experimental group, the surgery exhaust gas first passed laparoscopic surgical smoke purifier, the intake pipe of which was transformed from an aseptic transfusion device. Gas would emit a sound alert when passing the double-valve one-way valve. After passing KP100 grade, KN100 grade filter element and a certain amount of protective coal pellet activated carbon, the smoke would be managed by the independent negative pressure suction pipeline. The amount of carbon dioxide gas used in the two groups and the concentration of harmful substances in the smoke of the experimental group before and after the operation were recorded. Results The amount of carbon dioxide gas used in the control group was（ 656.95±70.11） L, which was higher than that in the experimental group （613.70±75.63） L, and the difference was statistically significant（ P 〈 0.01）. In the experimental group, PM10, PM2.5, PM1.0, formaldehyde and total volatile organic compounds（ TVOC） before the application of purifier were（ 206.90±30.48） μg/m3,（ 195.74±27.23） μg/m3,（ 220.22±37.60） μg/m3,（ 0.52±0.02） mg/m3 and（ 4.35±1.79） mg/m3, which were all higher than those after the application of purifier（ 4.26±1.02） μg/m3, （6.54±2.05） μg/m3,（ 7.89±3.38） μg/m3,（ 0.34±0.01） mg/m3 and（ 0.31±0.17） mg/m3 respectively, and the differences were statistically significant（ P〈0.01）. Conclusions The purifier can reduce the amount of carbon dioxide gas used in laparoscopic surgery, reduce the harmful substances in surgical exhaust gas and reduce the harm to the environment and medical staff.