即使局部电阻随通电而变化,电外科中的极低电压(VLV)模式也可以稳定而深入地通电组织。因此,在电外科止血中,VLV模式比其他凝血模式更可靠。在临床实践中,在VLV模式下,适当使用生理盐水滴注和抽血相结合,可以进一步提高凝血能力。然而,具体机制尚不清楚。本研究旨在评估VLV模式下电外科激活时间(ET)与止血组织效应(HTE)之间的关系。Further,验证了生理盐水滴注和抽吸对功耗和HTE的影响。
实验中包括12只重35kg的雌性猪。通过开腹手术建立肝出血模型,在不同条件下使用VLV模式尝试在出血性病变中止血(ET:3、6、9和12s,有/无盐水滴注和/或连续抽吸)。电气数据(如电压、电流,和阻力)在凝血过程中被提取。然后,评估了HTE的垂直/水平范围,并记录止血结果(成功或失败).
垂直/水平HTE,功耗,积分电流值与ET呈正相关。滴入生理盐水后,凝血深度加深(p<0.01)。然而,它不受连续抽吸的影响(p=0.20)。HTE面积随生理盐水滴注而增加(p<0.01),随吸力而减少(p<0.01)。功耗和积分电流随盐水滴注而增加(p<0.01),随吸力而降低(p<0.01)。单独滴注盐水的止血成功率降低(盐水滴注组48项试验中有31项[成功率=64.5%],对照组有44项/48项试验(成功率=91.7%))。然而,持续抽吸改善(46/48次试验[成功率=95.8%])。
电手术激活时间与止血组织效果呈正相关。盐水滴注增加了传热效率,但降低了止血成功率。因此,使用连续吸除生理盐水滴注提高止血效率。
The very-low-voltage (VLV) mode in electrosurgery can stably and deeply energize tissues even if the local electrical resistance changes with energization. Therefore, in electrosurgical hemostasis, the VLV mode is more reliable than other coagulation modes. In clinical practice, the appropriate use of combined saline drip and blood suction under the VLV mode can further enhance coagulation ability. However, the detailed mechanism is not known. The current
study aimed to evaluate the association between electrosurgical activation time (ET) and hemostatic tissue effect (HTE) under the VLV mode. Further, the effect of saline drip and suction on power consumption and HTE was validated.
Twelve female pigs weighing 35 kg were included in the experiment. A liver hemorrhage model was established via an open abdominal procedure, and hemostasis in the hemorrhagic lesion was attempted using the VLV mode under different conditions (ET: 3, 6, 9, and 12 s, with/without saline drip and/or continuous suction). Electrical data (such as voltage, current, and resistance) during coagulation were extracted. Then, the vertical/horizontal extent of HTE was assessed, and the hemostasis outcome (successful or failed) was recorded.
The vertical/horizontal HTE, power consumption, and integrated current value were positively correlated with the ET. The coagulation depth deepened with saline drip (p < 0.01). However, it was not affected by continuous suction (p = 0.20). The HTE area increased with saline drip (p < 0.01) and decreased with suction (p < 0.01). The power consumption and integrated current increased with saline drip (p < 0.01) and decreased with suction (p < 0.01). The success rate of hemostasis decreased with saline drip alone (31of 48 trials [success rate = 64.5%] in the saline drip group and 44/48 trials (success rate = 91.7%) in the control group). However, it improved with continuous suction (46/48 trials [success rate = 95.8%]).
The electrosurgical activation time was positively correlated with hemostatic tissue effect. Saline drip increased heat transfer efficiency but decreased the success rate of hemostasis. Therefore, the use of continuous suction in addition to saline drip increased hemostatic efficiency.