Harvey Mudd College, Claremont, California.
Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, California.
JAMA Surg. 2019 Oct 1;154(10):960-967. doi: 10.1001/jamasurg.2019.2515.
Smoke generated during surgical procedures has long been thought to be hazardous to hospital personnel; however, the degree of danger has yet to be determined.
The dangers of surgical smoke are associated with the composition of the plume. Small-particulate matter is found in the smoke that is easily inhaled. Particulates deposit in the lungs, circulatory system, and other organs, which may cause numerous health problems. The smoke also contains many gaseous compounds known to cause cancer. The type of tissue and the form of cautery have been shown to alter the composition of the surgical smoke. Well-cited articles have asserted that daily inhaled surgical smoke could be equivalent to smoking dozens of cigarettes. Unsafe levels of cancer-causing compounds have been found in the smoke. However, there is no firm evidence that operating room personnel show increased cancer rates compared with the general population. Data implicating other forms of passively inhaled smoke, such as fumes associated with cooking and wood burning, are likely comparable to the smoke issued during surgical procedures. Most operating rooms do not require smoke evacuation, and the elimination techniques are variable. Most systems rely on dispersion and, possibly, mechanical evacuation and filtration. Newer electric filters show promise but require more development.
Surgical smoke is dangerous, but the severity of the risk has yet to be determined. Therefore, no safe level is known at this point. Efforts should be made to reduce and possibly eliminate smoke from the operating room. Research into cost-effective forms of smoke evacuation is necessary. Studies of respiratory and cancer sequelae of exposure to operating room smoke in personnel who have had long-term exposure to surgical smoke is also needed.
长期以来，人们一直认为手术过程中产生的烟雾对医院工作人员有危险，但危险程度尚未确定。
手术烟雾的危害与羽流的成分有关。烟雾中发现了小颗粒物质，很容易被吸入。颗粒沉积在肺部、循环系统和其他器官中，可能导致许多健康问题。烟雾还含有许多已知会致癌的气态化合物。已经表明，组织的类型和烧灼的形式会改变手术烟雾的成分。引用良好的文章断言，每天吸入的手术烟雾可能相当于吸几十支香烟。烟雾中发现了不安全水平的致癌化合物。然而，没有确凿的证据表明手术室工作人员的癌症发病率高于普通人群。与手术过程中产生的烟雾相比，其他形式的被动吸入烟雾（如与烹饪和木材燃烧有关的烟雾）的数据可能相似。大多数手术室不需要烟雾排空，消除技术是可变的。大多数系统依赖于分散，可能还有机械排空和过滤。新型电过滤器显示出希望，但需要更多的开发。
手术烟雾是危险的，但风险的严重程度尚未确定。因此，目前还不知道安全水平。应努力减少并可能消除手术室中的烟雾。需要研究经济有效的烟雾排空形式。还需要对长期接触手术烟雾的人员进行暴露于手术室烟雾的呼吸和癌症后遗症的研究。
