Nduka C C, Super P A, Monson J R, Darzi A W
Central Middlesex Hospital, Department of Surgery, London, United Kingdom.
J Am Coll Surg. 1994 Aug;179(2):161-70.
Electrosurgical injuries occur during laparoscopic operations and are potentially serious. The overall incidence of recognized injuries is between one and two patients per 1,000 operations. The majority go unrecognized at the time of the electrical insult and commonly present three to seven days afterward with fever and pain in the abdomen. Since these injuries appear late the pathophysiology remains speculative.
This article reviewed the physics of electrosurgery and provides the surgeon with an insight to the mechanisms responsible in each type of injury. In addition, a comprehensive search of the world literature has reviewed all articles on the topic.
The main causes of electrosurgical injuries are: inadvertent touching or grasping of tissue during current application, direct coupling between a portion of intestine and a metal probe that is touching the activated probe, insulation breaks in the electrodes, direct sparking to the intestine from the diathermy probe, and current passage to the intestine from recently coagulated, electrically isolated tissue. The majority of injuries, not surprisingly, are caused by monopolar diathermy. Bipolar diathermy is safer and should be used in preference to monopolar diathermy, especially in anatomically crowded areas.
An awareness of the hazards of diathermy together with an understanding of the mechanisms of injury should enable the surgeon to dissect tissue and to achieve hemostasis, while at the same time decreasing the risk of serious complications to the patient.
电外科损伤发生于腹腔镜手术过程中，可能较为严重。已确认损伤的总体发生率为每1000例手术中有1至2例患者。大多数损伤在电损伤时未被识别，通常在之后三到七天出现发热和腹部疼痛。由于这些损伤出现较晚，其病理生理学仍具有推测性。
本文回顾了电外科的物理学原理，并让外科医生深入了解每种损伤类型的发生机制。此外，全面检索了世界文献，查阅了关于该主题的所有文章。
电外科损伤的主要原因包括：在电流施加过程中意外接触或抓取组织、一段肠管与接触激活探头的金属探头之间的直接耦合、电极的绝缘破损、透热探头直接向肠管放电以及电流从近期凝固的、电隔离的组织传导至肠管。毫不奇怪，大多数损伤是由单极透热疗法引起的。双极透热疗法更安全，应优先于单极透热疗法使用，尤其是在解剖结构复杂的区域。
了解透热疗法的危害并理解损伤机制应能使外科医生在解剖组织和实现止血的同时，降低患者发生严重并发症的风险。
