Hasar Zafer Burak, Ozmeric Nurdan, Ozdemir Burcu, Gökmenoğlu Ceren, Baris Emre, Altan Gökçen, Kahraman Sevil
Specialist, Medikodent, Ankara, Turkey.
Professor, Department of Periodontology, Gazi University Faculty of Dentistry, Ankara, Turkey.
J Oral Maxillofac Surg. 2016 Nov;74(11):2136-2141. doi: 10.1016/j.joms.2016.06.172. Epub 2016 Jun 21.
The disadvantages of conventional scalpels, including insufficient control of bleeding, prompted us to search for new alternative methods such as electrosurgery and radiosurgery. In this study, the conventional scalpel was compared with radiosurgery and electrosurgery for wound healing with assessment of lateral heat production, inflammation, and instrument performance.
Incisions were made in the palatal mucosa of 42 Wistar rats using a scalpel, electrocautery instrument, or radiofrequency instrument. Postoperative hemostasis, tissue coagulation, and tissue sticking were measured, and pain evaluation through weight loss was recorded. Gingival biopsy specimens from the surgical area were obtained at the time of surgery and 2, 4, 7, and 14 days postoperatively and were evaluated immunohistochemically for inducible nitric oxide synthase and heat shock protein 70. Kruskal-Wallis, 1-way analysis of variance, and Mann-Whitney U tests were used for statistical evaluation.
The rats in the electrosurgery and radiosurgery groups had aggressively greater weight loss when compared with the scalpel group in the first 7 days. Hemostasis was better in the electrocautery group, tissue coagulation was greater in the radiofrequency group (P < .001), and tissue sticking was lesser in the scalpel group (P < .001) compared with the other groups. Inducible nitric oxide synthase expression and heat shock protein 70 expression were similar in all 3 groups.
Electrosurgery performed better regarding hemostasis, whereas a scalpel was superior in terms of tissue sticking and tissue coagulation. Radiosurgery was superior regarding hemostasis when compared with a conventional scalpel, but it was not as successful as electrosurgery.
传统手术刀存在诸多缺点，包括对出血控制不足等，这促使我们探寻新的替代方法，如电外科手术和放射外科手术。在本研究中，将传统手术刀与放射外科手术和电外科手术在伤口愈合方面进行比较，评估侧向产热、炎症及器械性能。
使用手术刀、电灼器械或射频器械在42只Wistar大鼠的腭黏膜上进行切口。测量术后止血、组织凝固和组织粘连情况，并记录通过体重减轻进行的疼痛评估。在手术时以及术后2天、4天、7天和14天获取手术区域的牙龈活检标本，免疫组化评估诱导型一氧化氮合酶和热休克蛋白70。采用Kruskal-Wallis检验、单因素方差分析和Mann-Whitney U检验进行统计学评估。
与手术刀组相比，电外科手术组和放射外科手术组的大鼠在最初7天体重减轻更为明显。与其他组相比，电灼组止血效果更好，射频组组织凝固更显著（P <.001），手术刀组组织粘连更少（P <.001）。所有3组中诱导型一氧化氮合酶表达和热休克蛋白70表达相似。
电外科手术在止血方面表现更佳，而手术刀在组织粘连和组织凝固方面更具优势。与传统手术刀相比，放射外科手术在止血方面更具优势，但不如电外科手术成功。
