蒋烁,杨丹,刘文韬,郑靖,张浩,李可洲.高频电刀手术电极表面润湿性对胰管闭合效果的影响[J].表面技术,2022,51(2):367-374.
JIANG Shuo,YANG Dan,LIU Wen-tao,ZHENG Jing,ZHANG Hao,LI Ke-zhou.Effect of Surface Wettability of Active Electrodes in High-frequency Electrosurgical Unit on Pancreatic Duct Closure[J].Surface Technology,2022,51(2):367-374
高频电刀手术电极表面润湿性对胰管闭合效果的影响
Effect of Surface Wettability of Active Electrodes in High-frequency Electrosurgical Unit on Pancreatic Duct Closure
投稿时间:2021-06-18  修订日期:2021-08-29
DOI:10.16490/j.cnki.issn.1001-3660.2022.02.037
中文关键词:  高频电刀  手术电极  表面润湿性  组织粘附  胰管闭合
英文关键词:high-frequency electrosurgical unit  active electrode  surface wettability  tissue adhesion  pancreatic duct closure
基金项目:国家自然科学基金(51675356)
作者单位
蒋烁 西南交通大学 机械工程学院,成都 610031 
杨丹 西南交通大学 机械工程学院,成都 610031 
刘文韬 西南交通大学 机械工程学院,成都 610031 
郑靖 西南交通大学 机械工程学院,成都 610031 
张浩 四川大学 华西医院,成都 610041 
李可洲 四川大学 华西医院,成都 610041 
AuthorInstitution
JIANG Shuo School of Mechanical Engineering, Southwest Jiaotong University, Chengdu 610031, China 
YANG Dan School of Mechanical Engineering, Southwest Jiaotong University, Chengdu 610031, China 
LIU Wen-tao School of Mechanical Engineering, Southwest Jiaotong University, Chengdu 610031, China 
ZHENG Jing School of Mechanical Engineering, Southwest Jiaotong University, Chengdu 610031, China 
ZHANG Hao West China Hospital, Sichuan University, Chengdu 610041, China 
LI Ke-zhou West China Hospital, Sichuan University, Chengdu 610041, China 
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中文摘要:
      目的 研究手术电极表面润湿性对胰管闭合效果的影响,旨在从电极表面改性角度探索提升高频电刀防胰瘘效果的措施。方法 选用电外科临床常用的304不锈钢手术电极制备电极样品,利用化学刻蚀法在电极表面构建微结构,以改变电极表面润湿性,进而选用新鲜离体猪胰腺作为生物组织样品,使用高频电刀进行胰管闭合试验。对不同表面润湿性的电极样品进行胰管闭合试验后,观察表征电极表面的组织粘附、胰腺断面焦痂形貌、主胰管爆破压和胰腺残端组织损伤。结果 原始304不锈钢手术电极表面接触角为86.1°,经FeCl3溶液一步刻蚀处理后,表面形成微米级凹坑结构,接触角降至65.3°,再经HCl溶液两步刻蚀处理后,微米凹坑上形成纳米孔洞,接触角增大至111.5°。在相同的电外科手术模拟试验工况下,随着手术电极表面接触角的增大,电极表面组织粘附减轻,胰腺断面焦痂组织的孔洞尺寸变小,主胰管的闭合厚度增大、爆破压提高,胰腺残端组织损伤减轻。结论 在电外科手术过程中,高频电刀手术电极表面润湿性会影响胰管闭合效果。表面疏水化可以有效抵抗电极作用于胰腺组织时的表面组织粘附,抑制电极-胰腺组织界面的电弧放电,从而促进胰管的有效闭合,减轻胰腺残端组织损伤,降低术后胰瘘风险。
英文摘要:
      In this study, the influence of the surface wettability of active electrodes on pancreatic duct closure is investigated, aiming to explore measures that could improve the anti-pancreatic fistula effect of high-frequency electrosurgical unit from the perspective of electrode surface modification. 304 stainless steel active electrodes were used as electrode samples, and the surface wettability of electrode sample was changed by means of chemical etching treatment. Fresh isolated porcine pancreas was selected as biological tissue sample to do pancreatic duct closure test using a high-frequency electrosurgical unit. With respect to the electrode samples with different surface contact angles, the corresponding tissue adhesion on electrodes, the morphology of the eschar on pancreatic section, the blasting pressure of main pancreatic duct, and the tissue damage of pancreatic stump were examined after pancreatic duct closure test. Results showed that the surface contact angle was 86.1° for the original 304 stainless steel active electrode. A surface microstructure consisting of evenly distributed micron-pits was formed on the electrode surface after one step etching treatment with FeCl3 solution, and the contact angle was reduced to 65.3°. After a further etching treatment with HCl solution, nano-holes were formed on the micron-pits, and the contact angle was increased to 111.5°. Under the same electrosurgery conditions, as the contact angle of the electrode surface increased, the tissue adhesion on electrode surface was reduced, the size of the hole in the eschar tissue on the pancreatic section become small, the closed thickness and blasting pressure of the main pancreatic duct were increased, and the tissue damage of the pancreatic stump was decreased. In sum, during electrosurgery, the surface wettability of active electrodes has an influence on the closure of pancreatic duct. Electrode surface hydrophobization can effectively resist the adhesion of tissue onto the electrode when the electrode acts on pancreatic tissue, thereby inhibiting the arc discharge at the electrode-pancreatic tissue interface. This helps to promote the effective closure of the pancreatic duct, reduce the tissue damage to the pancreatic stump, and then reduce the risk of postoperative pancreatic fistula.
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