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題名 | A Comparison Among the Effects of Lasers, Electrocoagulator and Heat Probe for Partial Splenectomy in the Rabbit=雷射及熱探子對部份脾臟切除術效果之比較 |
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作者 | 陳肇真; 黃士銘; 靳應臺; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 28:5 民84.09-10 |
頁次 | 頁333-340 |
分類號 | 416.311 |
關鍵詞 | 雷射; 熱探子; 脾臟切除術; Heat probe unit; CO[feaf]laser; Nd: YAG laser; Partial splenectomy; |
語文 | 英文(English) |
中文摘要 | 脾臟為一重要免疫器官,其免疫機能在幼見時期尤其重要。因此,在各種原因欲切除脾臟時,應儘量保存脾臟組織。原則上,若能保留原脾臟組織的25%,即可對莢膜性細菌提供足夠的保護作用。但以往對於脾外傷,經常實施全脾切除術,其原因在於脾臟為一充血竇之實質性器官,以往的電刀很難達成有效的止血。 本研究是利用兔子作部份脾臟切除術。用來比較的工具包括:(1)傳統電刀;(2)熱探子;(3)C02雷射,非接觸性;(4)Nd: YAG雷射,單極性探頭,接觸型;(5)Nd:YAG雷射,雙極性探頭,接觸型。比較的項目包括:(1)手術所需時間;(2)手術之出血量;(3)需以線結紮的血管數目;(4)手術工具使用之方便性;(5)手術時因凝固所引起的煙量。由此可比較各種工具凝固及止血之功能。由功能順序好壞可排列如下:(1)Nd: YAG雷射;(2)C02雷射;(3)熱探子及傳統電刀。在Nd:YAG雷射中,有雙極性探頭的系統之止血效能比起單極性探頭系統者呈現有意義的差別。 在部份脾臟切除後第1天、第7天及第14天,將切除後剩餘之脾臟的切面於光學顯微鏡下觀察各種工具對於組織破壞之程度。在第一天時,以熱探子及傳統電刀造成之凝固性及出血性壞死最為廣泛,存活之脾臟很少;Nd: YAG雷射則造成極小範國之壞死,而脾臟之組織及淋巴生發中心( Germinal cenoer )均保存完善。於第14日時,可見到傳統電刀及熱探子作用後之脾臟組織大部為結疤組織取代;而Nd:YAG雷射組則僅有表層覆蓋少許瘢痕,大部份組織保存良好。C02雷射組之鏡下變化及破壞情形則介於以上兩者之間。而臨床手術的難易程度及效率則與鏡下所見之破壞程度呈正相關現象。 由本實驗結果,可知具有雙極性探頭的Nd:YAG雷射是兔子部份脾切除之良好工具。至於人類實際應用的成效則尚有待臨床經驗的建立。 |
英文摘要 | The purpose of this study was to compare the efficacy of various surgical hemostatic instruments in partial splenectomy of rabbits. The partial splenectomy was performed with the following tools: 1) Bovie electrocoagulator, 2) C02 Laser, 3) Heat Probe Unit, 4) Contact Nd: YAG Laser with unipolar probe, 5) Contact Nd: YAG Laser with bipolar probe. The parameters of efficacy were operation time, amount of bleeding, blood loss and number of sutures used in operation. The laser is superior to other tools from the aspect of postsplenctomy tissue damage and the area of fibrosis after recovery from operation. The contact Nd: YAG laser causes less tissue damage than the C02 laser. The contact Nd: YAG laser is also most clinically helpful as far as the time required for operation, bleeding amount, amount of smoking and sutures required in operation. Therefore, the contact Nd: YAG laser with synthetic ceramic sapphire probes proved to be an effective and competent method for partial splenectomy on rabbits. Its future application in pediatric and general surgery will be studied and evaluated. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。