高频电刀操作参数对组织损伤的影响研究

发布时间：2018-01-05 08:30

本文关键词：高频电刀操作参数对组织损伤的影响研究　出处：《西南交通大学》2017年硕士论文　论文类型：学位论文

【摘要】：高频电刀利用高频交流电产生的热效应对组织进行分离、切割和止血,但是,热效应将不可避免地对邻近正常组织造成热损伤,进而影响手术质量和病人的恢复效果。目前,国内外关于手术中高频电刀电极导致邻近组织损伤的研究多为临床统计,手术中电刀操作参数的选择主要依靠医生的经验,缺乏理论指导和明确标准,手术参数与组织损伤的映射关系亟待进一步探究。此外,为减轻切割过程中高频电刀电极表面组织粘附问题,近年来一些表面涂层电极被广泛研究、甚至用于临床,但是这些电极对邻近组织热损伤的影响却鲜有报道。因此,系统研究高频电刀操作参数对组织损伤的影响,阐明它们之间的映射关系,可为临床手术中高频电刀操作参数的选择提供参考。本论文以猪肝脏组织为生物试样,采用体外模拟试验和有限元分析相结合的方式,研究了混切模式下高频电刀输出功率和切割深度对组织热损伤的影响,综合切割效率和组织病理学切片分析,比较了不同参数下组织热损伤的差异,并在此基础上,考察了 PTFE涂层电极和钨涂层电极两种抗粘附电极对组织损伤的影响,分析了 PTFE涂层电极切割效率与组织热损伤之间的关联,探讨了钨涂层厚度对组织热损伤的影响。主要结论:(1)组织的切割效率、止血效果和热损伤均与高频电刀输出功率密切相关。低功率下,组织损伤以"白凝"为主,但白凝区较窄,止血不充分,切割效率低;随着功率增大,白凝区宽度增加,切口组织碳化,止血作用和切割效率提高;相同功率下,随着切割深度增加,切口邻近组织内的最高温度降低,损伤程度降低,但组织损伤区域呈现非线性增大。(2)PTFE涂层电极仅在切割初期具有较好的抗粘附效果,组织损伤轻,但其切割效率明显低于传统304不锈钢电极,增加输出功率能有效提高PTFE涂层电极的切割效率,但组织损伤显著加剧;随着切割时间增加,PTFE涂层逐渐失效,抗粘附效果减弱,切割效率增大,但组织损伤加剧。(3)304不锈钢电极表面纳米厚度的钨涂层对切口邻近组织热损伤程度和损伤范围均无显著影响。
[Abstract]:High frequency electric knife with high-frequency alternating current generated heat effect of separation, cutting and hemostasis, but the thermal effect will inevitably to the adjacent normal tissue caused by thermal damage, thereby affecting the quality of surgery and patient recovery. At present, at home and abroad on the operation of high frequency electric knife electrode leads to tissue damage to adjacent research clinical statistics, mainly rely on the operating parameters selection of electric knife surgery doctor's experience, the lack of theoretical guidance and clear standards, the mapping between the operation parameters and tissue injury need further explore. In addition, in order to reduce the cutting process of high frequency electric knife electrode surface adhesion problem in recent years, some surface coating electrode has been extensively studied, even for clinical, but effects of these electrodes on the adjacent tissue thermal damage is rarely reported. Therefore, systematic research on influence of high frequency electric knife operation parameters on tissue injury, To clarify the mapping relationship between them, which can provide reference for the clinical operation of high frequency electric knife choosing operation parameters. In this paper, the pig liver tissue for biological samples, using in vitro simulation test and finite element analysis of a combination of research, the mixed mode of high frequency electric knife cutting power and cutting depth influence on tissue thermal damage the comprehensive cutting efficiency and pathological analysis section, compare the different parameters between the tissues of thermal damage, and on this basis, the effects of PTFE coating electrode and tungsten coated electrode of two kinds of anti adhesion electrode effect on tissue injury, analysis of the association between PTFE coating electrode cutting efficiency and thermal damage, explore the influence of tungsten coating thickness on the thermal damage. The main conclusions: (1) the cutting efficiency of organization, hemostatic effect and thermal damage are closely related to the power output of high frequency electric knife. Low power, group Damage to white coagulation ", but the white coagulation zone is narrow, hemostasis is not sufficient, the cutting efficiency is low; with the power increasing, the width of the white coagulation area increases, incision tissue carbonization, hemostatic effect and improve the cutting efficiency; under the same power, with the increase of depth, the highest temperature in the lower incision of adjacent tissue, injury to reduce the degree of tissue damage, but the regional nonlinearly increase. (2) PTFE coating electrode only has good anti adhesion effect in cutting early, less tissue injury, but the cutting efficiency is significantly lower than that of the traditional 304 stainless steel electrodes, increase output power can effectively improve the cutting efficiency of PTFE coating electrode, but significantly increased with tissue injury; the cutting time increases, PTFE gradually weakened coating failure, anti adhesion effect, the cutting efficiency is increased, but the tissue damage increased. (3) 304 stainless steel nano electrode surface thickness of the tungsten coating on incision adjacent tissue thermal damage There was no significant effect on the damage range.

【学位授予单位】：西南交通大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R608

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