本文關(guān)鍵詞：高頻電刀操作參數(shù)對組織損傷的影響研究　出處：《西南交通大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 高頻電刀 手術(shù)電極 組織損傷 操作參數(shù) 體外模擬試驗 有限元仿真

【摘要】：高頻電刀利用高頻交流電產(chǎn)生的熱效應(yīng)對組織進行分離、切割和止血,但是,熱效應(yīng)將不可避免地對鄰近正常組織造成熱損傷,進而影響手術(shù)質(zhì)量和病人的恢復(fù)效果。目前,國內(nèi)外關(guān)于手術(shù)中高頻電刀電極導(dǎo)致鄰近組織損傷的研究多為臨床統(tǒng)計,手術(shù)中電刀操作參數(shù)的選擇主要依靠醫(yī)生的經(jīng)驗,缺乏理論指導(dǎo)和明確標準,手術(shù)參數(shù)與組織損傷的映射關(guān)系亟待進一步探究。此外,為減輕切割過程中高頻電刀電極表面組織粘附問題,近年來一些表面涂層電極被廣泛研究、甚至用于臨床,但是這些電極對鄰近組織熱損傷的影響卻鮮有報道。因此,系統(tǒng)研究高頻電刀操作參數(shù)對組織損傷的影響,闡明它們之間的映射關(guān)系,可為臨床手術(shù)中高頻電刀操作參數(shù)的選擇提供參考。本論文以豬肝臟組織為生物試樣,采用體外模擬試驗和有限元分析相結(jié)合的方式,研究了混切模式下高頻電刀輸出功率和切割深度對組織熱損傷的影響,綜合切割效率和組織病理學(xué)切片分析,比較了不同參數(shù)下組織熱損傷的差異,并在此基礎(chǔ)上,考察了 PTFE涂層電極和鎢涂層電極兩種抗粘附電極對組織損傷的影響,分析了 PTFE涂層電極切割效率與組織熱損傷之間的關(guān)聯(lián),探討了鎢涂層厚度對組織熱損傷的影響。主要結(jié)論:(1)組織的切割效率、止血效果和熱損傷均與高頻電刀輸出功率密切相關(guān)。低功率下,組織損傷以"白凝"為主,但白凝區(qū)較窄,止血不充分,切割效率低;隨著功率增大,白凝區(qū)寬度增加,切口組織碳化,止血作用和切割效率提高;相同功率下,隨著切割深度增加,切口鄰近組織內(nèi)的最高溫度降低,損傷程度降低,但組織損傷區(qū)域呈現(xiàn)非線性增大。(2)PTFE涂層電極僅在切割初期具有較好的抗粘附效果,組織損傷輕,但其切割效率明顯低于傳統(tǒng)304不銹鋼電極,增加輸出功率能有效提高PTFE涂層電極的切割效率,但組織損傷顯著加劇;隨著切割時間增加,PTFE涂層逐漸失效,抗粘附效果減弱,切割效率增大,但組織損傷加劇。(3)304不銹鋼電極表面納米厚度的鎢涂層對切口鄰近組織熱損傷程度和損傷范圍均無顯著影響。
[Abstract]:High frequency electric knife with high-frequency alternating current generated heat effect of separation, cutting and hemostasis, but the thermal effect will inevitably to the adjacent normal tissue caused by thermal damage, thereby affecting the quality of surgery and patient recovery. At present, at home and abroad on the operation of high frequency electric knife electrode leads to tissue damage to adjacent research clinical statistics, mainly rely on the operating parameters selection of electric knife surgery doctor's experience, the lack of theoretical guidance and clear standards, the mapping between the operation parameters and tissue injury need further explore. In addition, in order to reduce the cutting process of high frequency electric knife electrode surface adhesion problem in recent years, some surface coating electrode has been extensively studied, even for clinical, but effects of these electrodes on the adjacent tissue thermal damage is rarely reported. Therefore, systematic research on influence of high frequency electric knife operation parameters on tissue injury, To clarify the mapping relationship between them, which can provide reference for the clinical operation of high frequency electric knife choosing operation parameters. In this paper, the pig liver tissue for biological samples, using in vitro simulation test and finite element analysis of a combination of research, the mixed mode of high frequency electric knife cutting power and cutting depth influence on tissue thermal damage the comprehensive cutting efficiency and pathological analysis section, compare the different parameters between the tissues of thermal damage, and on this basis, the effects of PTFE coating electrode and tungsten coated electrode of two kinds of anti adhesion electrode effect on tissue injury, analysis of the association between PTFE coating electrode cutting efficiency and thermal damage, explore the influence of tungsten coating thickness on the thermal damage. The main conclusions: (1) the cutting efficiency of organization, hemostatic effect and thermal damage are closely related to the power output of high frequency electric knife. Low power, group Damage to white coagulation ", but the white coagulation zone is narrow, hemostasis is not sufficient, the cutting efficiency is low; with the power increasing, the width of the white coagulation area increases, incision tissue carbonization, hemostatic effect and improve the cutting efficiency; under the same power, with the increase of depth, the highest temperature in the lower incision of adjacent tissue, injury to reduce the degree of tissue damage, but the regional nonlinearly increase. (2) PTFE coating electrode only has good anti adhesion effect in cutting early, less tissue injury, but the cutting efficiency is significantly lower than that of the traditional 304 stainless steel electrodes, increase output power can effectively improve the cutting efficiency of PTFE coating electrode, but significantly increased with tissue injury; the cutting time increases, PTFE gradually weakened coating failure, anti adhesion effect, the cutting efficiency is increased, but the tissue damage increased. (3) 304 stainless steel nano electrode surface thickness of the tungsten coating on incision adjacent tissue thermal damage There was no significant effect on the damage range.

【學(xué)位授予單位】：西南交通大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R608

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