超声刀在腹腔镜手术治疗子宫内膜异位症中的效果评价

目的评估超声刀在腹腔镜手术治疗子宫内膜异位症的效果。方法随机将247例子宫内膜异位症患者分为超声刀腹腔镜组与单纯腹腔镜组,对比分析两组的手术情况、症状改善情况、术后并发症、术后复发率和自然妊娠率。结果超声刀腹腔镜组在手术时间、出血量、术后发热、胃肠功能恢复等指标均显著优于单纯腹腔镜组。超声刀腹腔镜组的术后痛经改善率明显高于单纯腹腔镜组（72.1%vs.35.9%,P〈0.01）;术后复发率明显低于单纯腹腔镜组（4.1%vs.18.5%,P〈0.01）;术后妊娠率明显高于单纯腹腔镜组（61.1%vs.34.2%,P〈0.01）。结论超声刀腹腔镜手术治疗各期子宫内膜异位症具有微创、出血少、恢复快,术后并发症少等优势,且与单纯腹腔镜手术结果比较,术后妊娠率明显增加,值得临床推广。     

Preliminary study of electrocautery smoke particles produced in vitro and during laparoscopic procedures

Background: The objective of this preliminary study was to describe the particles contained in cautery smoke produced during five laparoscopic procedures and verify the collection method during three laboratory experiments on ex vivo animal tissue. Methods: A cascade impactor collected the smoke according to particle size, and particle weights were calculated on an electronic microbalance. Electron microscopic analysis and energy dispersive X-ray evaluation were used to determine particle morphology and elemental composition. Results: The particles, distributed according to size on the seven rotating trays of the impactor, had diameters ranging from 0.05 to >25 m, with most being 0.1–1 m. In vitro experiments yielded more particles, especially larger (>5 m) ones, than the surgical procedures, because the cauterized specimens could be placed much closer to the cascade impactor in the laboratory environment, eliminating most obstacles to particle recovery. In the laparoscopic surgery patients, larger particles, because of their physical properties, were more likely to remain trapped in the abdomen or to drop off in the collection apparatus. Uniformly, two populations of particles were demonstrated—either large, irregular fragments (2–25 m) rich in carbon and oxygen, suggesting structural cellular components, or small homogeneous spheres (0.1–0.5 m) composed of sodium, magnesium, calcium, and potassium salts. Conclusions: This study demonstrates the presence of breathable areosols and cell-size fragments in the cautery smoke produced during laparoscopic procedures. Their exact chemical composition and potential adverse effects for patients and personnel are not known.     

超声刀和电刀在腹腔镜手术中产生主要有害气体的临床对比研究

目的 探讨腹腔镜手术中应用超声刀和电刀切割组织产生的主要有害气体及与切割时间的关系。方法 选择腹腔镜胆囊手术患者80例,要求术前无吸烟病史,随机分为超声刀手术组及电刀手术组,对比两组手术中产生的主要有害气体。结果 超声刀组手术完成37例,电刀组手术完成42例,电刀组1例中转开腹。两组手术中均产生CO及丙烯腈类,超声刀手术组较电刀手术组产生的CO及丙烯腈类均要少（P＜0.05）;在一定的时间内两组产生的CO浓度随着切割时间延长而升高。结论 腹腔镜二氧化碳气腹条件下均产生CO及丙烯腈类有毒气体,超声刀手术组较电刀手术组产生的有害烟气较少,相对安全。     

超声刀与高频电刀在腹腔镜肾上腺肿瘤切除术应用中的比较

目的探讨超声刀在腹腔镜肾上腺肿瘤切除术中的应用。方法腹腔镜下采用高频电刀和超声刀进行。肾上腺肿瘤切除术,对比分析两组各项手术指标（手术时间、术中出血、输血例数、术中血压剧烈波动例数、中转开放例数、术后胃肠道功能恢复时间、术后起床活动时间、引流量、拔管时间、术后住院天数）之间的差别。结果超声刀组全部顺利完成腹腔镜肾上腺肿瘤切除术,而高频电刀组2例中转开放手术。与高频电刀组比较,超声刀组手术时间明显缩短（62．7±26．5minvs90．51±40．3min）,术中出血明显减少（30．8±3．28mlvs110．6±25．71ml）,术后排气时间及下床活动时间提前（1．1±0．3dvs2．0±0．6d）,术后引流量较少（12．6±7．2mlvs32．5±6．5）,术后住院时间缩短（5．5±2．15dvs7．0±2．5d）。术后随访6个月至5年,无肿瘤复发及残余肿瘤,肾上腺疾病临床症状、体征改善。结论超声刀在腹腔镜。肾上腺肿瘤切除术中具有止血确切、术野清晰、热传导低等优点,临床应用安全可靠。     

腹腔镜下应用超声刀阑尾切除术280例体会

目的:探讨超声刀在腹腔镜阑尾切除术(LA)中应用的可行性。方法:回顾性分析280例应用超声刀行阑尾切除术的临床资料。结果:除1例中转开腹外全部用超声刀完成阑尾切除,无需特殊耗材,无术后并发症。结论:用超声刀行LA术安全、便捷、明显提高手术效率。     

超声刀处理胆囊血管的应用研究

目的　探讨超声刀处理胆囊血管的可行性。　方法　应用超声刀对 2条犬腹腔内血管采用 2档输出功率、低张力、弱抓持力、钝刀头的条件 ,沿血管滑动封合、离断管径 (1～ 11)mm的动、静脉血管。在此基础上应用于腹腔镜胆囊、胆道手术的胆囊血管处理。　结果　对犬腹腔内管径≤ 9mm的血管封合、离断效果良好 140 / 15 0 (93.3% ) ,术中及术后无血管断端出血。应用于临床腹腔镜胆囊、胆道手术 70 6例 ,术中及术后无血管断端出血。　结论　腹腔镜手术中可直接使用超声刀封合、离断胆囊动脉。     

超声刀与电刀在乳腺癌手术中应用效果比较的Meta分析

目的:比较超声刀与传统电刀用于乳腺癌术中乳房组织切除、腋窝淋巴结清扫的疗效。方法:检索国内外数据库,收集相关随机对照试验(RCT),行文献筛选、质量评价和资料提取后,应用RevMan 5.2软件完成Meta分析。结果:共纳入8个RCT,总样本量604例,其中超声刀组300例,电刀组304例。Meta分析结果显示,与电刀组比较,超声刀组手术时间无明显差异(WMD=6.20,95%CI=-5.02~17.41,P=0.28),但术中出血量(WMD=-61.42,95%CI=-83.76~-39.09)、术后引流量(WMD=-374.92,95%CI=-453.90~-295.95)、引流时间(WMD=-3.30,95%CI=-5.10~-1.49)、术后皮下积液发生率(RR=0.51,95%CI=0.38~0.68)均明显降低(均P0.05)。结论:乳腺癌手术中,使用超声刀在控制术中出血量、减少术后引流、降低术后皮下积液方面优于电刀。     

超声刀在腹腔镜手术中的应用

目的：观察超声刀在复杂的腹腔镜手术中的切割止血效果。方法：比较使用超声刀（57例）和高频电刀（50例）行腹腔镜手术的临床效果。结果：所有病例均在腹腔镜下完成手术，无1例中转开腹，无术中及术后并发症或大出血发生。使用超声刀的平均手术时间，平均出血量均少于使用高频电刀者。结论：超声刀具有精确切割，凝血可控制的功能，损伤小，提高了腹腔镜手术的安全性及微创水平，是一种重要和有用的腹腔镜手术设备。     

超声刀联合高频电凝断肝法在腹腔镜肝部分切除术中的应用

目的 探讨超声刀联合高频电凝断肝法在腹腔镜肝切除术中的应用价值.方法 回顾性分析浙江省人民医院2007年3月至2009年11月间21例腹腔镜肝切除的临床资料.结果 21例腹腔镜肝部分切除均成功,无一例因出血而中转开腹.术中联合使用超声刀和高频电凝断肝,其中解剖性肝切除9例,局部切除12例,手术时间65～250 min,...     

超声刀在腹腔镜脾切除术中的临床应用

目的:探讨腹腔镜结合超声刀在脾切除术中的临床应用价值。方法:应用腹腔镜结合超声刀行脾切除12例,其中脾亢4例,外伤脾7例,脾肿瘤1例,均在全麻下实施腹腔镜手术。结果:12例手术均获成功,手术平均时间150m in。无严重并发症发生,仅1例术后2周发生脾窝积液并感染,经手术引流痊愈。结论:腹腔镜结合超声刀行脾切除术具有较高的实用价值,在严格掌握手术适应证的基础上,腹腔镜行中等肿大以下脾切除术是可行的。     

超声刀在腹腔镜子宫切除术中的应用

目的 :探讨腹腔镜下应用超声刀行筋膜内子宫切除术 (CISH)、腹腔镜协助阴式子宫切除术(LAVH)的可行性。方法 :对用超声刀施术 2 4 0例与用单极电刀行子宫切除 16 0例和用双极电凝行子宫切除16 0例的手术时间、手术难度、术中腹腔出血量及患者术后恢复情况进行比较。结果 :超声刀手术组在手术时间 ,术中腹腔出血量 ,术后体温恢复 ,术后肛门排气时间 ,术后患者自觉症状等方面明显优于单极电刀手术组和双极电凝手术组。结论 :超声刀在子宫切除手术中具有安全、可靠、作用迅速、操作便捷等优点 ,有很高的临床应用价值     

Use of the ultrasonic dissecting scalpel in laparoscopic cholecystectomy

Background: We evaluated the use of the ultrasonically activated (harmonic) scalpel (HS) in the performance of laparoscopic cholecystectomy (LC). Methods: A total of 282 consecutive patients, 64 of whom had acute cholecystitis at the time of surgery, underwent LC using HS dissection. Indications for surgery included chronic pain (180 cases), episodes of acute cholecystitis (89 cases), pancreatitis (five cases), and jaundice (seven cases). Twenty-seven patients had preoperative endoscopic retrograde cholangiopancreatography (ERCP). Results: The mean operating time was 29 ± 9 mins. Eleven procedures were converted to open surgery, (four due to bleeding, six due to unclear anatomy, and one due to an inflammatory mass caused by gangrene/perforation). Complications occurred in 14 patients. They included minor port site infection (four cases), pulmonary atelectasis (three cases), urinary retention (two cases), intraoperative cathetherization not routinely performed, bile leak (two cases, both from cystic duct; one of the cystic duct leaks occurred because of dislodgement of the occluding clip, the other may have been due to duct injury from the clip), pulmonary embolus (one case), and myocardial infarction (one case). Neither of the latter complications were fatal. One patient required a postoperative transfusion due to a fall in hematocrit of 3.2 gr/dl. Conclusions: LC performed with the HS is feasible and effective. Operating time and blood loss were minimal, and the conversion rate was low (3.9%). There were no bile duct injuries. Use of the HS makes dissection easier, thereby helping to reduce operative time and lower the need for conversion to open surgery. Received: 30 April 1999/Accepted: 22 November 1999/Online publication: 4 August 2000     

腹腔镜良性卵巢囊肿剔除术使用超声刀及单、双极电凝对卵巢功能的近期影响

目的:研究腹腔镜良性卵巢囊肿剔除术使用超声刀及单、双极电凝对卵巢功能的近期影响。方法:单侧卵巢囊肿拟行囊肿剔除术116例患者,随机分为对照开腹组、超声刀组、单极电凝组、双极电凝组。所有患者分别于术前、术后1月、术后3月抽血测定E2、P、T、FSH、LH的水平,并进行术后随访。结果:四组病例在术后1月均出现E2下降及FSH、LH增高,分别与术前比较差异有显著意义(P<0.05),但4组之间FSH、LH、E2比较无差异(P>0.05)。术后3月各种激素水平与术前及术后1月比较无显著差异(P>0.05)。术后三个月以单极电凝组和对照开腹组导致月经异常的较其它组例数多,但4组间比较无显著差异(P>0.05)。结论:腹腔镜手术使用超声刀、单极及双极电凝不加重卵巢近期功能的损害。     

Comparison of posttonsillectomy pain using the ultrasonic scalpel, coblator, and electrocautery.

OBJECTIVE: To compare postoperative tonsillectomy pain between 3 commonly used surgical devices: the Harmonic Ultrasonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH), the Coblator (ArthroCare Corp, Sunnyvale, CA), and electrocautery. STUDY DESIGN AND SETTING: A prospective, randomized trial. One hundred thirty-four patients were randomly assigned to receive a tonsillectomy with 1 of 3 surgical devices. All patients were asked to fill out a postoperative diary. RESULTS: Statistically significant differences in pain scores were revealed between the Coblator and electrocautery (P = 0.02) and between the Coblator and the Ultrasonic Scalpel (P = 0.003), with the Coblator having lower pain scores. Electrocautery and the Ultrasonic Scalpel did not differ significantly from each other. The Coblation method showed a strong trend toward quicker return to normal diet. CONCLUSION: Patients undergoing tonsillectomy with the Coblator device reported less pain over a 10-day period than patients undergoing tonsillectomy with electrocautery or the Ultrasonic Scalpel. Pain after tonsillectomy remains a major issue for our patients. The choice of surgical instrument appears to be one way to reduce this pain. EBM rating: A-1b.     

Ultrasonically activated scalpel in laparoscopic surgery advantages and limits

The disadvantage of monopolar coagulation, the limits of the bipolar coagulation and the frequent changes of instruments during laparoscopic procedures, are three elements that make the harmonic dissectors very useful in laparoscopic surgery. MATERIAL AND METHOD: In Surgery Clinic were operated with anatomic scalpel (HS), in the last month: 50 cholecystectomies, 25 appendectomies, 12 partial ovarectomies, 10 anexectomies and 2 splenectomies. We used 5 and 10 mm instruments, especially the ETICON scissors. RESULTS AND CONCLUSIONS: After our short experience with HS and in concordance with literature, we consider that: The advantages are: the features to coagulate nearest delicate anatomic structures (biliary tree, large bowel, blood vessels) the absence of the smog and the slag; the scissors is a versatile device which allow the dissection and the coagulation without changes the instruments. The limits are: hemorrhages after insufficient coagulation or prehension, the necessity of the learning curve, high costs of the disposable materials. The HS device represent a real progress, especially for that laparoscopic surgery which requires the coagulation of blood vessels placed in thick and fat structures.     

超声刀与高频电刀在腹腔镜胆道探查术中的对比研究

目的:对比研究超声刀(ultrasonic harmonic scalpel,UHS)与高频电刀(high-frequency mono-polar electronic scalpel,HMES)在腹腔镜胆道探查术(laparoscopic common bile duct exploration,LCBDE)中的应用价值。方法:回顾分析216例LCBDE患者的临床资料,其中98例术中应用UHS(A组),118例术中应用HMES(B组);对比分析两组手术时间、术中出血量、中转开腹率、术后胆漏率、术后出血量及住院时间;检测两组患者术前及术后第1天、第3天、第5天ALT、AST、TBIL、DBIL、GGT、ALP水平。结果:两组患者手术时间、术中出血量、中转开腹率、术后胆漏率、术后出血量及住院时间差异均无统计学意义(P>0.05);肝功能检测显示,与术前比较,A组术后第1天,B组术后第1天、第3天ALT、AST明显升高(P<0.05),第5天两组均恢复至正常水平;术后第3天两组间差异有统计学意义(P<0.05)。两组患者术后第3天、第5天TBIL、DBIL水平较术前及术后第1天显著降低,术后第5天较第3天显著下降(P<0.05);术后第5天两组ALP、GGT较术前显著下降,两组间相比差异无统计学意义(P>0.05)。结论:LCBDE术中应用UHS、HMES均是安全、有效的,可有效解除胆道梗阻。     

超声刀在结直肠癌手术中的应用

目的 比较开腹结直肠癌根治手术中使用超声刀与电刀的临床效果.方法 将同期收治的结直肠癌患者随机分成使用超声刀(30例)与电刀(32例)行根治术两组,比较两种方法的效果.结果 超声刀组和电刀组平均切口长度分别为(6 ±2)cm和(15±4)cm,平均术中出血量分别为(50±6)mL和(150±30)mL,差异均有统计学意义(均P＜0.05).超声刀组和电刀组手术时间分别为(130±25)min和(145±30)min,淋巴结清扫数目分别为(13±6)个和(12±5)个,两者无统计学差异(均P＞0.05);超声刀组术后镇痛时间、肛门排气时间、住院时间与引流量优于电刀组(均P＜0.05),术后并发症两组无差异(均P＞0.05).结论 开放结直肠癌根治手术中使用超声刀较使用电刀具有损伤小,术后恢复快等优点.     

Cost analysis comparing ultrasonic fundus-first and conventional laparoscopic cholecystectomy using electrocautery

Background

Costs associated with laparoscopic fundus-first cholecystectomy using ultrasonic dissection versus a conventional laparoscopic cholecystectomy has not been compared.

Methods

Adult patients subjected to elective laparoscopic cholecystectomy between June 2002 and March 2004 were randomized to either an ultrasonic fundus-first dissection or dissection from the triangle of Calot with electrocautery. Differences in direct and indirect costs related to either technique were studied.

Results

The duration of the operation and hospitalization was longer when dissection was with the conventional technique. With the ultrasonic fundus-first technique, the direct cost was 1,190 SEK lower, and the total cost, taking also the cost for sick leave into account, was 5,370 SEK lower.

Conclusions

Both direct and indirect costs are lower with a laparoscopic fundus-first cholecystectomy using ultrasonic dissection than conventional laparoscopic cholecystectomy using electrocautery.