腹腔镜结直肠手术能量设备的特点及意外处理  

Characteristics and accidental treatment of energy instruments in laparoscopic colorectal surgery

作　　者：张宏[1] 刘鼎盛[1] ZHANG Hong;LIU Ding-sheng(Department of General Surgery,Shengjing Hospital,China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院普通外科结直肠肿瘤外科,辽宁沈阳110004

出　　处：《中国实用外科杂志》2022年第11期1250-1255,共6页Chinese Journal of Practical Surgery

基　　金：辽宁省民生科技计划项目(No.2021JH2/10300053)。

摘　　要：腹腔镜结直肠手术离不开各种能量设备。层面寻找与拓展,血管裸化与离断,淋巴结清扫都需要合理使用器械。了解各种能量设备的特点,熟练掌握不同器械的正确使用方式,根据不同手术场景合理选择使用不同器械,安全快速地达到解剖目的是每位结直肠外科医生应该掌握的基本技能。单极电钩尽量使用可手动控制激发的产品,使用时组织牵拉要保证足够的张力,凝血时要时刻提防发生热损伤。双极电凝主要用于止血操作。超声刀使用时尽量小口夹持组织,工作面刀头不要接触血管、神经及重要脏器,避免长时间激发导致刀头温度升高。LigaSure止血效果较好,但不适合精细解剖操作,建议用于裁剪肠系膜。无论使用哪种能量设备,都要注意可能引发的血管、神经、输尿管、肠壁损伤。一旦发现可疑损伤,尽量术中给予及时对症处理,解除隐患,以免出现术后并发症,造成不必要的二次手术。Laparoscopic colorectal surgery is inseparable from various energy instruments.The search and expansion of layers,the denudation and disconnection of blood vessels,and the dissection of lymph nodes all need to use instruments reasonably.In order to complete anatomy and dissociation quickly and accurately,the colorectal surgeon should understand the characteristics of various energy instruments,master the correct use of different instruments skillfully,and select and use different instruments reasonably according to different surgical scenarios.The monopolar electrosurgical scissors shall use products that can be activated manually as far as possible.When using,the tissue shall be pulled to ensure sufficient tension.When clotting,thermal damage shall be prevented at all times.Bipolar electrosurgical scissors are mainly used for hemostasis.When using the Harmonic Scalpel,clamp the tissue as small as possible.The ultrasonic jaw shall not contact blood vessels,nerves,and important organs,to avoid the high temperature of the ultrasonic jaw caused by long-time excitation.LigaSure has a good hemostatic effect,but it is not suitable for fine dissection,so it is recommended to be used for mesenteric clipping.No matter what kind of energy instrument is used,attention should be paid to possible injuries to blood vessels,nerves,ureters,and intestinal walls.Once the suspected injury is found,timely symptomatic treatment shall be given during the operation as far as possible to remove hidden dangers so as to avoid postoperative complications,which may cause reoperation.

关 键 词：结直肠手术 腹腔镜 能量设备 

分 类 号：R6[医药卫生—外科学]