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題 名 | 雙極電燒法之原理及臨床應用 |
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作 者 | 謝銘鈞; 翁昭旼; 王正一; | 書刊名 | 醫學工程 |
卷 期 | 4:2 1992.04[民81.04] |
頁 次 | 頁5-10 |
分類號 | 415.5091 |
關鍵詞 | 雙極電燒法; 息肉切除術; 內視鏡手術; Biopolar electosungery; Polypectomy; Endoscopic surgery; |
語 文 | 中文(Chinese) |
中文摘要 | 絕大部份的經内視鏡電燒手術法都是利用單極電燒原理來完成的,煞而它也不是絕對安全無虞的;根據文獻統計:約有百分之七十的不經意組織燒傷是由於對極皮的放置不當所造成的,而這也是祇有在單極電燒法時才有的併發症。此外,出血、穿孔及對側腸壁燒傷等也是時有所聞,尤其當内視鏡醫不十分了解機械原理及生體反應時,更容易因此造成憾事。臺大醫院内科再過去十二年中(1975~1987)共施行1000次息肉切除術。其中6.5%是局部癌施,共發生0.9%,其中0.2%較嚴重需輸血。美國二年前發展出來的雙極電燒線圈,由於施行電燒術時不必在病人體表放置對極板,因此可以百分之百去除對極板燒傷及對側腸燒傷的併發症。當使用雙極電燒線圈作息肉切除術時,由於電流被限制在線圈周圍,而不會像單極電燒術時產生回流電流穿透組織而去,因此對四周及深層肌肉層損傷極少,穿孔的可能性也大大減少。又由於對組織損傷輕微,使用在治療消化道早期癌症的粘膜切除術時,可以使我們更準確地判斷切除標本斷端是否乾淨。雖煞出血的後遺症尚不能完全解決,但是雙極電燒術機械原理俱有單極電燒術無法取代的優點,實在值得在臺灣推廣應用。 |
英文摘要 | The great majority of endoscopic electrosurgery is accomplished as a monopolar procedure which is not without risk. It is estimated that 70% of all unintended electrosurgical burns are resulted from fault condition at return electrode site which is necessary only in a monopolar procedure to complete the electrical circuit. And other complications including bleeding, perforation and alternate site bowel burns are not infrequent, especially when the endoscopist is not well experienced in this procedure. The recently developed bipolar electrosurgical polypectomy snare will totally eliminate the possibility of alternate site bowel burns and return electrode burns during endoscopic polypectomy due to absence of electrical current passing through the tissue to the distant return electrode, as in monopolar procedures. The bipolar electrosurgical currents are confined between the dual eletrodes of the snare and polyp tissue closely encircled by the dual electrodes without obviously deep penetration and lateral extension of electric current; therefore, the bipolar snare requires significantly less energy than the monopolar snare to cut the equivalent amounts of tissue. Consequently, the extent of burn damage is minimized, the risk of perforation reduced. And because of this very characteristics of less tissue damage during electrosurgery, the bipolar snare also playes an important role in the endoscopic surgery of early gastric cancer and early colorectal cancer, namely mucosectomy or strip biopsy in which detailedly pathological evaluation of the specimen is essential in order to make sure whether the surgical margin is free from involvement by cancer cells or not. Although the complication of bleeding is not totally resolved yet at present, the advantage mentioned above indicate that bipolar snare bears the feasibility of clinical applications and merits further evaluation. |
本系統中英文摘要資訊取自各篇刊載內容。