ACT对肝素盐水洗脱手术器械肿瘤细胞效果的影响  

Effect of ACT on outcomes of washing-out tumor cells on surgical instruments

作　　者：张剑英 季萍 顾则娟[2] 杨美玲 吴云松 周滋霞[4] 

机构地区：[1]南京医科大学第一附属医院手术室,江苏省210029 [2]南京医科大学第一附属医院护理部,江苏省210029 [3]南京医科大学第一附属医院病理科,江苏省210029 [4]南京医科大学护理学院

出　　处：《江苏医药》2014年第17期1991-1993,共3页Jiangsu Medical Journal

基　　金：国家临床重点专科建设基金资助[财社(2010)305]

摘　　要：目的探讨ACT对肝素盐水洗脱手术器械肿瘤细胞效果的影响。方法行巨块型(肿瘤体积10cm>>5cm)肝脏肿瘤切除术69例的操作肿瘤手术器械均先在肝素盐水洗脱中涮洗6-8s,然后再用生理盐水复洗。参考每例患者的术前全血激活凝血时间(ACT),将操作肿瘤手术器械洗脱前延迟时间分为短于患者的ACT(A组)和长于ACT(B组)两组,采用液基薄片细胞学检查法检测两组洗脱手术器械的肝素盐水液(反映操作肿瘤手术器械携带的肿瘤细胞数)和生理盐水洗脱液(反映手术器械洗脱后的残留肿瘤细胞数)中的肿瘤细胞数。结果 A组器械携带的肿瘤细胞数少于B组[(0.01±0.00)个vs.(1.10±0.12)个](P<0.05);A组器械残留肿瘤细胞阳性率低于B组(3.3%vs.30.0%)(P<0.05)。结论采用术中返回操作肿瘤手术器械,于短于患者ACT的时间内实施肝素盐水涮洗,能有效减少操作肿瘤手术器械携带肿瘤细胞数和涮洗后的残留肿瘤细胞数。Objective To investigate the effect of activated clotting time（ACT）on the outcomes of washing-out tumor cell on surgical instruments.Methods The surgical instruments touching tumor in 69 cases undergoing surgery for huge liver cancer were washed in a heparin-saline elution solution firstly and in normal saline thereafter.According to ACT of each case before operation,the surgical instruments were assigned into two groups.The time from the instrument being passed to it instrument nurse to being put into washing solution was less than his ACT in group A,while that in group B was longer than ACT.The number of tumor cells in the heparin-saline solution（reflecting the tumor cell numbers carried by the instruments）and normal saline（reflecting the residual tumor cell numbers on the instruments after washing-out by the heparin-saline solution）was counted by liquid based thin cytology examination.Results The tumor cell number carried by the instruments was less in group A than that in group B[（0.01±0.00）pieces vs.（1.10±0.12）pieces]（P0.05）.The positive rate of residual tumor cells on the instruments was lower in group A than that in group B（3.3% vs.30.0%）（P0.05）.Conclusion Washing-out tumor cells on surgical instruments with the heparin-saline solution in a time delay of less than ACT of the patient can effectively reduce the tumor cell numbers carried by the instruments and the residual tumor cell numbers on the instruments after washing-out.

关 键 词：手术器械无瘤技术 肝素盐水器械洗脱液 激活凝血时间 

分 类 号：R472[医药卫生—护理学]