Birch D W, Park A, Shuhaibar H
Department of General Surgery, McMaster University, St. Joseph's Hospital, Hamilton, Ontario, Canada.
Am Surg. 1999 Apr;65(4):334-7.
Electrocautery-induced thermal injury contributes to morbidity and mortality after laparoscopic surgery. Ultrasonic dissection is an alternative technique that may produce less thermal injury. We compared the amount of acute thermal injury caused to jejunal free flaps isolated with laparoscopic electrosurgical instruments with that caused by ultrasonic dissection (laparoscopic coagulating shears). Canine jejunal free flaps were isolated by electrocautery or laparosonic coagulating shears and remained viable on a vascular pedicle. After a period of ischemia and reperfusion, the flaps were resected to simulate harvesting and reimplantation. Thermal injury was observed at the site of dissection and was graded histologically. At the margin of the jejunal free flaps, the laparosonic coagulating shears produced less thermal injury (score, 2.2 at level 3) than the electrocautery grasping forceps (score, 3.7 at 35 W and 4.1 at 70 W). The laparosconic coagulating shears produced less thermal injury to a jejunal free flap than did electrocautery. Ultrasonic dissection is an alternative to the complications produced by electrocautery during laparoscopic dissection.
电灼引起的热损伤会导致腹腔镜手术后的发病和死亡。超声分离是一种可能产生较少热损伤的替代技术。我们比较了用腹腔镜电外科器械分离空肠游离皮瓣所造成的急性热损伤量与超声分离（腹腔镜凝固剪）所造成的热损伤量。通过电灼或腹腔镜超声凝固剪分离犬空肠游离皮瓣，并使其在血管蒂上保持存活。经过一段时间的缺血和再灌注后，切除皮瓣以模拟获取和再植入。在分离部位观察到热损伤，并进行组织学分级。在空肠游离皮瓣边缘，腹腔镜超声凝固剪产生的热损伤（3级时评分为2.2）比电灼抓钳少（35W时评分为3.7，70W时评分为4.1）。腹腔镜超声凝固剪对空肠游离皮瓣产生的热损伤比电灼少。超声分离是腹腔镜分离过程中电灼所致并发症的一种替代方法。
