有源腔镜器械的绝缘性能检测及破损原因分析

The test of insulating property of active endoscopic instrument and analysis of damaged reason

目的:检测有源腔镜器械的绝缘性能,分析绝缘破损原因,制定常规绝缘性能检测质量控制规范。方法:应用目测法和仪器检测法对18根单极电钩和42根绝缘外套管进行绝缘性能检测,计算有源腔镜器械的绝缘破损点的数量、绝缘破损率,并可视化分析破损分布情况,基于根因分析法分析绝缘破损的原因。结果:目测法和仪器检测法均检测出单极电钩存在绝缘破损,两者检测出的绝缘破损比率分别是52.38%和16.67%;仪器检测法检测出的绝缘破损点数量是目测法的6倍,且在人力成本、时间成本和检测精度上优于目测法。检测出的42个绝缘破损点在绝缘外套管前部、中部和后部的分布情况分别为45.24%(19/42)、38.1%(16/42)和16.67%(7/42)。有源腔镜器械的使用次数、手术手法和灭菌方式是导致绝缘层破损的主要因素。结论:有源腔镜器械存在较高的绝缘破损率,应建立定期用绝缘检测仪对器械进行绝缘性能检测的制度与技术规范,以保证其在手术中的安全使用。

Objective To explore the clinical significance that insulating property of active endoscopic instrument was regular tested. Methods： Visual method and instrument detection method were applied to test insulating property of 18 monopolar electronic hooks and 42 insulated outer thimble. And the amount of damaged dots of active laparoscopic instrument, damaged rate and distribution of damaged dots were calculated. And the reason of damaged insulation materials were further analyzed. Results： Both of the two methods can find out damaged insulation material that existed in the monopolar electronic hook, and damaged rates of insulated outer thimble of instrument detection method and visual method were 52.38% and 16.67%, respectively. The amount of damaged dots that were found by instrument detection method was 6 times of that by visual method, and it was better than that of visual method in the terms of manpower cost, time cost and detection accuracy, respectively. The distribution of 42 damaged dots on the insulated outer thimble included front zone （19/42, 45.24%）, middle zone（16/48, 38.1%） and back zone（7/24, 16.67%）. Conclusion： The use frequency, surgical technique and sterilization method of active laparoscopic instrument were the main factors that cause the damage of insulation layer. There is higher damaged rate of insulation in the active laparoscopic instrument. Therefore, the instrument should be routinely tested by using insulation detector so as to ensure the safe application of active laparoscopic instrument.