Kennedy J S, Stranahan P L, Taylor K D, Chandler J G
Valleylab, Inc., 5920 Longbow Drive, Boulder, CO 80301, USA.
Surg Endosc. 1998 Jun;12(6):876-8. doi: 10.1007/s004649900733.
The inherent tedium of intracorporeal knot tying has stimulated greater interest in energy-based and mechanical alternatives for hemostasis.
Three hundred thirty-one arteries and veins were sealed by application of precisely controlled electrothermal energy and physical pressure, allowing for brief cooling in compression, in experimental animals and fresh abattoir vessels. These seals were compared for bursting strength with occlusions by ultrasonic and bipolar coagulation, surgical clips, and ligatures.
Ultrasonic and bipolar occlusions were significantly less likely to have burst strengths greater than 400 mmHg as compared with seals, clips, and ligatures (p < 0.001). Seal competence could be visually assessed by its translucence.
Precise energy control with physical compression, including a brief cooldown, produces a distinctive, translucent seal of partially denatured protein that can typically be transected after a single application. These seals have bursting strengths comparable to those of clips and ligatures and resist dislodgement because they are intrinsic to the vessel wall structure.
体内打结固有的乏味促使人们对基于能量和机械的止血替代方法产生了更大兴趣。
在实验动物和新鲜屠宰场血管中，通过施加精确控制的电热能量和物理压力来封闭331条动脉和静脉，在压缩过程中允许短暂冷却。将这些封闭与通过超声和双极电凝、手术夹和结扎进行的闭塞在破裂强度方面进行比较。
与封闭、夹子和结扎相比，超声和双极闭塞的破裂强度大于400 mmHg的可能性显著降低（p < 0.001）。封闭的完整性可通过其半透明性进行视觉评估。
精确的能量控制与物理压缩，包括短暂冷却，会产生一种独特的、半透明的、部分变性蛋白质的封闭，通常单次应用后即可切断。这些封闭的破裂强度与夹子和结扎相当，并且由于它们是血管壁结构固有的，所以能抵抗移位。
