Tseng Hsin-Shun, Liu Shi-Ping, Uang Shi-Nian, Yang Li-Ru, Lee Shien-Chih, Liu Yao-Jen, Chen Dar-Ren
Comprehensive Breast Cancer Center, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua 50006, Taiwan.
World J Surg Oncol. 2014 Feb 4;12:31. doi: 10.1186/1477-7819-12-31.
Electrocautery applications in surgical operations produce evasive odorous smoke in the cleanest operation rooms. Because of the incomplete combustion of electrical current in the tissues and blood vessels during electrocautery applications, electrocautery smoke (ES) containing significant unknown chemicals and biological forms is released. The potential hazards and cancer risk should be further investigated from the perspective of the occupational health of surgical staff.
The particle number concentration and the concentration of polycyclic aromatic hydrocarbons (PAHs) in ES were thoroughly investigated in 10 mastectomies to estimate the cancer risk for surgical staff. The particle number concentration and gaseous/particle PAHs at the surgeons' and anesthetic technologists' (AT) breathing heights were measured with a particle counter and filter/adsorbent samplers. PAHs were soxhlet-extracted, cleaned, and analyzed by gas chromatography/mass spectrometry.
Abundant submicron particles and high PAH concentrations were found in ES during regular surgical mastectomies. Most particles in ES were in the size range of 0.3 to 0.5 μm, which may potentially penetrate through the medical masks into human respiration. The average particle/gaseous phase PAH concentrations at the surgeon's breathing height were 131 and 1,415 ng/m³, respectively, which is 20 to 30 times higher than those in regular outdoor environments. By using a toxicity equivalency factor, the cancer risk for the surgeons and anesthetic technologists was calculated to be 117 × 10(-6) and 270 × 10(-6), respectively; the higher cancer risk for anesthetic technologists arises due to the longer working hours in operation rooms.
The carcinogenic effects of PAHs in ES on the occupational health of surgical staff should not be neglected. The use of an effective ES evacuator or smoke removal apparatus is strongly suggested to diminish the ES hazards to surgical staff.
在最洁净的手术室中，外科手术中的电灼操作会产生刺鼻的烟雾。由于电灼操作过程中组织和血管内电流的不完全燃烧，会释放出含有大量未知化学物质和生物形态的电灼烟雾（ES）。应从外科工作人员职业健康的角度进一步研究其潜在危害和癌症风险。
在10例乳房切除术中，对ES中的颗粒数浓度和多环芳烃（PAHs）浓度进行了全面研究，以评估外科工作人员的癌症风险。使用颗粒计数器和过滤器/吸附剂采样器，测量外科医生和麻醉技术人员（AT）呼吸高度处的颗粒数浓度和气态/颗粒态PAHs。PAHs经索氏提取、净化后，用气相色谱/质谱法进行分析。
在常规外科乳房切除术中，ES中发现了大量亚微米颗粒和高浓度的PAHs。ES中的大多数颗粒尺寸在0.3至0.5μm范围内，可能会穿透医用口罩进入人体呼吸道。外科医生呼吸高度处的平均颗粒相/气相PAH浓度分别为131和1415 ng/m³，比常规室外环境中的浓度高20至30倍。通过使用毒性当量因子，计算出外科医生和麻醉技术人员的癌症风险分别为117×10⁻⁶和270×10⁻⁶；麻醉技术人员的癌症风险较高是由于其在手术室的工作时间较长。
ES中PAHs对外科工作人员职业健康的致癌作用不容忽视。强烈建议使用有效的ES抽气器或烟雾清除装置，以减少ES对外科工作人员的危害。
