射频能量和压合压强对射频肠吻合口的爆破压影响

目的：结直肠癌切除后需要进行肠道吻合术,缝合线和吻合钉会残留异物引起并发症,射频热焊接技术既可完成无异物残留的快速肠道吻合,又可以应用在腹腔镜手术中。利用射频能量和压力作用于肠壁,完成肠道吻合,研究压合压强和能量对爆破压的影响。方法：从屠宰场采集猪结肠,2小时内运至实验室,在特制的模拟射频肠吻合器上完成焊接吻合,采用2种压合压强和2种射频能量,共4组。焊接部位插入热电偶,测量焊接过程的最高温度,爆破压测量装置测量吻合口爆破压,病理切片H＆E染色和扫描电镜图像观察焊接部位。统计学方法分析焊接爆破压差异。结果：射频能量一定时,压合压强改变对爆破压的影响不显著（p〉0.05）,但焊接部位最高温度随压合压强增大而升高,最高温度达142°C。压合压强一定时,射频总能量改变对爆破的影响不显著（p〉0.05）,焊接部位最高温度变化不明显。结论：射频焊接时,仅增大压合压强或仅提高射频能量不能有效的提升爆破压,但焊接温度会随压力提高,不利于控制对周围组织的热损伤。

Effect of Energy and Compressive Pressureon Burst Pressure Inradiofrequency-induced Colonic Anastomosis

Objective：Intestinal anastomosis should be conducted after resection of colorectal cancer.While residual of foreign materials by suture and stapler results in complications.Radio frequency-induced thermo-fusion applied in colonic anastomosis is faster without any foreign material,which can be used in laparoscopic surgery.Compete colonic anastomosis by radio frequency-induced thermo-fusion and study effect of energy and compressive pressure on burst pressure.Methods：Fresh colon were harvested from slaughter house and delivered to lab within 2 hours.Two levels of compressive pressure and energy were applied to weld colon samples exvitroona customer-made device that simulating an anastomotic instrument.Thermal couple was inserted into fusion area torecord temperature during welding process.Burst pressure was measured and observed fused area by pathological sections（HE） and scan electrical microscopy.Results：No significant different on burst pressure was observed when use different compressive pressure but the same energy though temperature increases with rising compressive pressure.The maximal temperature was142°C.Similarly,no differenton burst pressure and temperature when use different energy but the same compressive pressure.Conclusions：Burst pressure cannot be enhanced by increasing compressive pressure or RF energy independently.Temperature rising with increasing compressive pressure dose not benefit to limit thermal spread.