甲状腺手术中能量器械热损伤的对比研究

Abstract

目的 比较电刀、超声刀及LigaSure等能量器械对甲状腺组织的热损伤差异.方法 将12只比格犬分为3组:15 w电刀组、三档超声刀组、中间档LigaSure组,分别以能量器械作用于甲状腺表面组织.作用过程中以红外热成像仪检测组织温度情况,并留取作用后的组织标本观察热损伤深度.结果 15 w电刀作用3s时的最高温度为(83.9±8.2)℃,热损伤深度为(0.96±0.07)mm;3档超声刀激发3s时最高温度为(70.7±7.5)℃,热损伤深度为(0.74±0.07) mm;LigaSure作用时最高温度为(56.6±5.7)℃,热损伤深度为(0.72±0.11)mm.3组间的最高温度比较差异有统计学意义,超声刀与LigaSure的热损伤深度相当,差异无统计学意义(P=0.845).15w电刀产生的热损伤深度较超声刀及LigaSure均明显增大,差异有统计学意义(P＜0.01).结论 LiagSure与超声刀及电刀相比产生的热量更小,LigaSure和超声刀造成的组织热损伤较轻,是甲状腺手术中较为安全的能量器械.

Objective Energy based surgical devices such as high frequency electrotome,Harmonic scalpel and LigaSure are widely used in thyroid operations.This study is to demonstrate the difference of tissue thermal damage among different surgical instruments.Methods 12 beagle dogs were randomly divided into 3 groups,electrotome 15 W groups (group A),three-speed Harmonic scalpel (group B) and LigaSure middle gear group (group C).Patients of each group received energy instruments operating on their thyroid tissue which mimics traditional thyroidectomy.The temperatures of gland tissue during procedures were monitored by infrared thermal imager,and the operated thyroid tissues were histologically analyzed.Results The highest temperature was (83.9±8.2)℃ in the electrotome group,(70.7±7.5)℃ in three-speed Harmonic scalpel group,and (56.6±5.7)℃ in LigaSure group.The highest temperature among the three groups was statistically significant.The electrotome (15 W) caused more serious thermal damage to thyroid tissues than that caused by either the Harmonic scalpel or LigaSure (thermal damaged depth:(0.96±0.07) mm vs (0.74±0.07) mm,P＜0.01;(0.96±0.07) mm vs (0.72± 0.11) mm,P＜0.01).Nevertheless,the thermal damage had no significant differences between the Harmonic scalpel and LigaSure group (P=0.845).The thermal damage caused by the 15 W electrotome was significantly larger than that in the other two groups,and the difference had statistical significance (P＜0.01).Conclusion Compared to the high frequency electrotome,Harmonic scalpel and LigaSure lead less tissue thermal damage during thyroid surgeries,owing to less heat production.In that way,Harmonic scalpel and LigaSure are superior to electrotome in terms of safety.