超声刀和结扎速血管闭合系统闭合血管的可靠性及组织损伤程度研究

目的 研究超声刀和结扎速血管闭合系统闭合血管的可靠性及组织损伤程度。方法 普通雌性狗2只，分别用超声刀和结扎速闭合并切断狗两侧动静脉血管，测量血管破裂压。血管破裂压实验完成后，将闭合血管剪断，制成切片，观察血管组织损伤程度。结果 结扎速闭合的血管破裂压明显高于超声刀。超声刀能有效闭合直径31mm或更细的血管。结扎速能成功闭合所有血管。超声刀闭合血管组织损伤从闭合边缘延伸距离小于结扎速，组织损伤主要局限在血管壁外膜层。结扎速组织损伤扩至外膜层和肌肉层。结论 结扎速闭合血管的可靠性大于超声刀，特别是直径大于3mm的血管。超声刀能有效闭合直径3mm或更细的血管，组织损伤程度小于结扎速。     

不同功率双极电凝对山羊肠系膜血管热损伤及止血效果的研究

目的研究双极电凝不同功率对山羊肠系膜血管组织的热损伤程度及对血管的止血效果的影响,指导腹腔镜手术中双极电凝功率的选择。方法截取173段山羊肠系膜血管组织,以不同功率行肠系膜血管凝断术测量热损伤宽度;特定功率下电凝肠系膜血管组织记录单次电凝血管闭合成功率。结果 55~80 W之间,功率越小,热传导损伤宽度越小,差异有统计学意义(P0.05)。60 W功率双极单次电凝血管闭合成功率较高,热损伤宽度最小,差异有统计学意义(P0.05)。结论双极电凝在60 W左右为较适合工作功率,热损伤范围小,血管止血效果好。     

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

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、作用住点、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.     

结扎速血管闭合切割系统在完全腹腔镜下全子宫切除术中应用

目的 探讨结扎速血管闭合切割系统(LigaSure)在子宫切除术中应用价值及手术技巧.方法 回顾性分析应用LigaSure血管闭合系统行完全腹腔镜下全子宫切除术156例患者临床资料.结果 156例患者均在腹腔镜下顺利完成手术,无中转开腹手术病例；手术时间1.5～2 h；发生输尿管损伤1例.结论 LigaSure血管闭合系统可直接闭合大部分血管和组织血管束,有助于缩短手术时间、减少术中出血量,术后并发症少,患者恢复较快.     

结扎速血管闭合系统在妇科腹腔镜应用的效果观察及护理配合

目的探讨结扎速血管闭合系统在妇科腹腔镜手术中应用的护理配合。方法回顾性分析106例结扎速血管闭合系统在妇科腹腔镜手术中的手术护理配合过程。结果本组病例手术过程顺利,出血少,均痊愈出院。结论做好术前准备、熟悉结扎速血管闭合系统的使用方法及做好器械保养及管理等,可为手术的顺利进行提供可靠的保证。     

竹牙签在结扎速血管闭合系统手机清洗中的应用

妇科腹腔镜辅助经阴子宫切除、宫外孕行腹腔镜下输卵管切除等手术，常使用结扎速血管闭合系统进行切割或快速凝血。由于结扎速血管闭合系统的使用，避免了术中缝扎止血，医生操作简单，病人恢复快等优点，现已广泛应用。但结扎速手机的清洁相当困难，特别是齿缘轴节部位，一般采用5ml注射器的针头，剔去焦痂。但用针头清洁耗时费力，易划伤手机的面板，甚至刺断通电的细导线，造成永久性损害，     

结扎速血管闭合切割系统在腹腔镜全子宫切除术中的应用与护理体会

目的探讨结扎速血管闭合切割系统(结扎速)在腹腔镜全子宫切除术中的应用与护理体会。方法回顾性分析64例患者应用结扎速行腹腔镜下全子宫切除的手术配合。结果本组手术均在腹腔镜下顺利完成,无中转开腹,出血少,手术时间短。结论充分的术前准备,熟悉结扎速结构性能、基本原理、操作程序和保养知识是确保手术顺利完成的前提条件。     

缝扎卵巢韧带在腹腔镜子宫切除术中的应用

目的:探讨缝扎卵巢韧带在腹腔镜子宫切除术中的应用价值.方法:将92例行腹腔镜次全子宫切除术(LSH)和腹腔镜辅助的阴式子宫切除术(LAVH)患者分别随机分为两组,术中分别应用缝扎法及双极电凝法处理卵巢韧带,观察手术时间及术中出血情况.结果:缝扎法和双极电凝法处理卵巢韧带在两种术式中手术时间差异均无统计学意义(P>0.05),但出血量差异有统计学意义(P<0.05).结论:应用缝扎法在腹腔镜子宫切除时处理卵巢韧带,能有效减少出血量,手术更加方便快捷.     

结扎速血管闭合系统在腹腔镜肝血管瘤切除术中的应用价值

目的探讨腹腔镜肝血管瘤切除术中结扎速血管闭合系统的应用价值。方法总结分析3例肝血管瘤患者腹腔镜肝切除术中应用结扎速血管闭合系统离断肝脏的方法体会及治疗效果。结果3例手术均取得成功,平均手术时间105min（60～180min）,术中平均出血400mL（100～800mL）,平均住院日8d,无并发症,全部治愈出院。结论腹腔镜肝切除术中应用结扎速血管闭合系统离断肝组织安全有效,疗效满意,可降低费用,实现了低成本微创外科。     

Ligusure血管闭合系统与传统缝扎在阴式全子宫切除术中的比较

目的比较Ligusure血管闭合系统（简称结扎速）与传统缝扎在阴式全子宫切除术中的比较，探讨结扎速可行性、安全性、优越性。方法回顾性分析36例结扎速成功完成的非脱垂子宫病人及36例传统缝扎成功完成的非脱垂子宫病人经阴式全子宫切除术，在观察手术时间、术中出血量、并发症、术后住院时间等方面比较。结果应用结扎速平均手术时间30min，术后排气时间15．3h，术中平均出血量21ml，术后平均住院时间4．5d。结论结扎速在阴式全子宫切除术中安全，明显缩短手术时间，并发症无明显增加，与传统缝扎阴式手术相比具有明显优越性。     

Ligasure联合杯状举宫器在腹腔镜下全子宫切除术中的应用

目的探讨结扎速血管闭合系统(Ligasure)联合杯状举宫器在腹腔镜下全子宫切除术中的临床应用价值。方法 2010年5~11月,使用Ligasure、杯状举宫器在腹腔镜下行子宫全切除47例。结果 47例均顺利完成,手术时间60~120min,平均70 min。出血量20~80 mL,平均50 mL,术后有1例盆腔脓肿,经阴道盆腔脓肿引流及抗感染治疗成功。结论 Ligasure联合杯状举宫器行腹腔镜下全子宫切除术方便、快捷、有效,值得推广。     

Ligasure 联合超声刀在腹式宫颈癌根治术中的应用

目的:探讨Ligasure(血管闭合系统)联合超声刀在腹式宫颈癌根治术中的应用。方法:回顾分析2003年6月￣2005年2月我院45例应用Ligasure联合超声刀的腹式宫颈癌根治术及73例未应用的腹式宫颈癌根治术临床资料,比较手术时间、术中出血量、术后恢复排尿时间。结果:应用组手术时间短于未应用组,术中出血量少于未应用组,2组相比较有显著差异(P<0.05)。术后恢复排尿时间无显著性差异(P>0.05)。结论:腹式宫颈癌根治术使用Ligasure联合超声刀能缩短手术时间,减少术中出血量,Ligasure联合超声刀值得临床在腹式宫颈癌根治术中推广使用。     

Ligasure血管闭合系统在经阴道子宫全切除术中的应用

【目的】探讨Ligasure血管闭合系统经阴道子宫全切除术的价值。【方法】对62例应用Ligasure血管闭合器系统经阴道子宫全切除术（A组）与同期62例普通阴式子宫全切术（B组）在手术成功率、平均手术时间、平均出血量、平均住院时间、术后并发症、术后肛门排气时间、平均住院费用等方面进行比较。【结果】两组在平均手术时间、平均出血量、术后肛门排气时间、住院天数等方面有显著性差异（P〈0．05）;平均住院费用、手术成功率、术后并发症方面无显著性差异（P〉0．05）。【结论】应用Ligasure血管闭合器系统经阴道子宫全切除术较传统阴式子宫全切具有手术时间短、出血量少、肛门排气早、住院天数少等优点,值得推广。     

Comparison of selective uterine artery double ligation at the isthmic level of uterus and bipolar uterine artery coagulation in total laparoscopic hysterectomy

Abstract

In this article, we would like to compare the clinical characteristics and effectiveness of selective uterine artery double ligation and bipolar uterine artery coagulation in total laparoscopic hysterectomy (TLH) retrospectively. TLH was performed on 72 patients with selective uterine artery double ligation and on 312 patients with uterine artery bipolar coagulation in tertiary university hospital from January 2004 through January 2006. Both groups were similar with respect to age, body mass index, parities, rate of menopause and uterine weight. The mean transfusion, postoperative hospital stay and drain insertion in the selective uterine artery double ligation group were significantly lower than those in the bipolar uterine artery coagulation group in TLH, respectively (p < .05). There were no differences in the hemoglobin, hematocrite change, additional operations, operation time, rate of complication between the two kinds of operation (p > .05). In conclusion, selective uterine artery double ligation in TLH showed lower transfusion rate, less hospitalization and less discomfort due to drain than bipolar uterine artery coagulation. Also, it did not take a longer time for operation and thus provides a feasible and secure method to manage uterine vessels at the level of uterine isthmus inside of the broad ligament.     

Principles and initial experience of a new device for dissection and hemostasis.

Electrosurgery is a commonly used technology in laparoscopy. Electrosurgical devices are being used in many medical subdisciplines in order to coagulate, cut, and ablate tissue and to produce hemostasis. The latest advance in electrosurgery is the introduction of novel simultaneous hemostatic sealing and cutting bipolar devices that minimize force by delivering energy as high current and low voltage output. One of these systems is the Gyrus Plasma Trissector (GPT), (Gyrus Group PLC, Gyrus International, Ltd.UK), a novel radiofrequency (RF) system based on bipolar technology, which consists of a proprietary PlasmaKinetic (PK) generator and specific instruments, designed as a system. The instrument consists of a 17 mm long gold-coated curved jaw with a ceramic insulated cutting element. The PK system uses high-powered pulsed bipolar energy to produce a plasmakinetic field around the working elements and is designed to operate at temperatures that allow effective tissue dissection but result in minimal collateral damage and adherence to tissue. The GPT was used with the Gyrus G400 WorkStation generator in laparoscopic radical prostatectomies (LRP). Our initial experience with this novel bipolar device demonstrates it to be safe and effective in dissection and hemostasis. The GPT permits us to act quickly when bloody fields are present, improves coagulation, reduces or eliminates sticking, seals large vessels such as dorsal vein complex (DVC) and allows secure grasping and dissecting of tissue. The urologist is familiar with electrosurgery, as we have become comfortable using GPT to dissect, cut, and coagulate tissue. We feel that the GPT can be used in a variety of laparoscopic procedures in urology.     

Laparoscopic splenectomy with a vessel sealing device

When compared with open splenectomy, laparoscopic splenectomy was associated with fewer complications, however, with more hemorrhagic complications. Furthermore, the mean operative time for laparoscopy was significantly longer than for the open procedure. Vessel sealing systems are represented as decreasing operative time and blood loss in several surgical procedures. The aim of this study is to evaluate the blood loss and operating time of laparoscopic splenectomy with a vessel sealing system. We evaluated 19 laparoscopic splenectomies with a vessel sealing device, particularly focusing on operative blood loss and operating time. Patients were operated in the right lateral decubitus position usually with three ports. In all cases, dissection of the spleen and sealing of hilar vessels and short gastric vessels were performed with a vessel sealing system. No clips, sutures, or monopolar–bipolar diathermy were used. Mean operative blood loss was 88ml (range 20–400?ml) and mean operative time was 107 minutes (range 45–230?minutes). Both results were better than those of most series of laparoscopic splenectomy performed with endostaplers or endoclips. Laparoscopic splenectomy with a vessel sealing system is safe for all vascular controls in laparoscopic splenectomy and can lead to less blood loss. This technique removes the disadvantage of longer operating times for laparoscopic as compared to open splenectomy.     

不同手术方式对子宫肌瘤患者卵巢功能的影响

目的探讨不同手术方式对子宫肌瘤患者卵巢功能的影响。方法将120例子宫肌瘤的患者根据腹腔镜下手术方式不同分为子宫肌瘤剔除组、全子宫切除组、全子宫切除及输卵管切除组,各40例。比较术前、术后三组的血清抗苗勒管激素(AMH)、促卵泡生成素(FSH)、雌二醇(E2)水平及窦状卵泡数(AFC),通过Kupperman问卷调查表评估更年期症状判定患者的卵巢功能。结果术后,全子宫切除组、全子宫切除及输卵管切除组AMH、E2水平均降低,全子宫切除及输卵管切除组的FSH水平升高(P<0.05);术后,全子宫切除组FSH、E2水平低于子宫肌瘤剔除组(P<0.05);全子宫切除及输卵管切除组FSH水平高于子宫肌瘤剔除组和全子宫切除组,E2水平低于子宫肌瘤剔除组和全子宫切除组(P<0.05);术后3个月,全子宫切除组、全子宫切除及输卵管切除组AFC均减少(P<0.05)。所有患者术后均无潮热等更年期相关症状。结论本研究中,腹腔镜下子宫肌瘤剥除术对卵巢功能无影响,腹腔镜下全子宫切除术及全子宫双侧输卵管切除术对卵巢功能有一定的影响,但不显著。     

腹腔镜卵巢囊肿剔除术中不同止血方式对于卵巢功能的影响

目的探讨腹腔镜卵巢囊肿剔除术中不同止血方式对于卵巢功能的影响。方法本院行腹腔镜卵巢囊肿剔除术的单侧卵巢囊肿患者92例,随机分为3组:单极电凝组31例,双极电凝组30例,镜下缝合止血组31例。比较3组患者术前、术后1个月、术后3个月的月经变化、激素水平、手术时间、出血量、卵巢动脉血流参数、窦卵泡数及术后排卵等指标。结果镜下缝合止血组和双极电凝组的术后性激素水平恢复、排卵情况月经情况显著优于单极电凝组,镜下缝合止血组的术后的围绝经期综合征发生率显著低于电凝组,镜下缝合止血组术后的收缩期峰值流速(PSV)、窦状卵泡数目(AFC)与术前相比差异显著。结论镜下缝合止血方式可以保护卵巢储备功能,提高患者的卵巢功能和术后的生活质量,不良反应少,值得临床推广应用。