单极电凝与结扎速血管闭合系统对子宫超微结构及肠功能影响的比较  

Comparison of the effects of monopolar coagulation and ligasure vessel sealing system on uterine ultrastructure and bowel movement

作　　者：闫彩平[1] 韩玉英[2] 祝育德[1] 邝国超 沈丹[1] 

机构地区：[1]暨南大学第三附属医院妇科,广东珠海519000 [2]暨南大学医学院临床系,广东广州510180 [3]广东省珠海市第二人民医院妇科,广东珠海519000

出　　处：《中国内镜杂志》2011年第12期1255-1258,共4页China Journal of Endoscopy

摘　　要：目的观察腹腔镜全子宫切除术单极电凝与结扎速血管闭合系统(Ligasure)对子宫肌细胞超微结构及机体肠功能的影响。方法收集暨南大学第三附属医院2009年12月～2010年12月行腹腔镜下全子宫切除术的患者60例,按术中止血方式的不同,分为单极电凝组30例、Ligasure组30例,记录两组所有患者手术时间、术中出血量、术中肛温、术前术后(24、48h)体温、术后排气排便的时间;随机抽取两组切除子宫标本各8个,标本取两侧宫角部与输卵管电凝离断部位,取焦痂下在光镜下观察未发生变化组织制作电镜标本,寻找共性组织改变摄片,了解两组超微结构的改变情况。结果两组患者术后体温、排气时间及排便时间差异无显著性(P>0.05);单极电凝组手术时间明显长于Ligasure组,术中出血量明显多于Ligasure组(P<0.05)。单极电凝组所有标本电镜下出现膜的破损,线粒体扩张,染色质边集、核浓缩或核碎裂、溶解。Ligasure组只有1例出现子宫肌细胞膜的破损,细胞器及细胞核未见明显变化。结论单极电凝对10mm外的凝切组织电镜下已发生了超微结构的改变,但这种热损伤的程度与Ligasure组相比,不影响术后体温及肠功能的恢复,使用时掌握正确的电流参数、作用位点、作用时间及作用终止指标,最大程度地降低单极电凝的热损伤。Objective To investigate the effects of monopolar coagulation and ligasure vessel sealing system on uterine ultrastructure and body＇s bowel movement in laparoscopically total hysterectomy.Method A total of 60 patients accepted laparoscopically hysterectomy in the Third Affiliated Hospital of Jinan University from December 2009 to December 2010 were divided into two groups according to different hemostasis methods,30 patients in the monopolar coagulation group,30 patients in the Ligasure group.The operating time,blood loss,postoperative recovery were analyzed.8 random sample from each group were chosen.The part with no change under microscope were selected to make transmission electron microscope sample,and the general changes and the distance from the dissection were recorded.Results There were no significant difference between the two groups in postoperative temperature,recovery time of intestinal function and bowel moment （P 0.05）.The operating time and blood loss were less in the ligasure group.The changes included cell membrane breakage,mitochondrion expansion,nucleolus pyknosis,smash or karyolysis in monopolar group.Conclusion The uterine ultrastructural change of monopolar coagulation occurs at 10 mm outside the dissection.So we should select the correct current characteristic,acting locus,acting time and the stop indicator when using monopolar coagulation to decrease the thermal injury as possible as you can.

关 键 词：腹腔镜 单极电凝 结扎速血管闭合系统 超微结构 温度 肠功能 

分 类 号：Q248[生物学—细胞生物学] R711.7[医药卫生—妇产科学]