表面氮化鉻塗層功能薄膜於電燒外科手術之電極基材上降低熱損傷與組織粘黏

Surface Coating Functional Film of Chromium Nitride on Electrode Decreases Thermal Damage and Tissue Sticking in Electrosurgery of Surgical Operation

王成志(CHEN-CHIH WANG)

指導教授 ： 黃茂栓

臺北醫學大學/口腔醫學院/醫療器材產業碩士專班/碩士(2013年)

https://doi.org/10.6831/TMU.2013.00133

摘要

電燒外科手術中最被關切的是熱損傷與組織沾黏所影響之傷口重建。本研究藉由不同電極來探討內部熱損傷之導致對於老鼠肝之重建影響。一單極電燒機伴隨著未處理不銹鋼(SS)與氮化鉻鍍層不銹鋼(CrN-SS)之電極被用於成年老鼠之肝病變處理，而老鼠於手術0、3、7與28天後被犧牲。由老鼠體重與進食記錄結果顯示；經SS不銹鋼與CrN-SS不銹鋼之電極處理後皆呈現相同之術後疼痛評分。此外，CrN-SS不銹鋼會比SS不銹鋼產生較低之組織沾黏與熱損傷，而總面積之損傷亦指出於每個時間點上CrN-SS不銹鋼會比SS不銹鋼更低。CrN-SS不銹鋼會導致一相對較小之內部熱損傷與纖維組織及快速重建過程於老鼠之肝中。經CrN-SS不銹鋼處理後之組織螢光染色與西方墨點分析亦呈現出較低的NF-κB與caspase-3反應。因此，本研究揭示於不銹鋼電極表面披覆一層氮化鉻是一有效可改善電燒電極之性能方法並有助於傷口重建。

關鍵字

電燒手術 ； 組織沾黏 ； 熱損傷 ； 氮化鉻

並列摘要

Thermal damage and tissue sticking, which influence wound remodeling, are major concerns in electrosurgery. In this study, the effect of lateral thermal injury caused by different electrosurgical electrodes on hepatic remodeling was investigated. A monopolar electrosurgical unit equipped with untreated stainless steel (SS) and chromium nitride coated stainless steel (CrN-SS) electrodes was used to create lesions on the liver lobes of adult rats. Animals were sacrificed for evaluations at 0, 3, 7, and 28 days post-operatively. Results of the body weight changes and food intake records revealed that rats treated with SS electrode, or CrN-SS electrode had same postoperative pain scores. CrN-SS needles generated lower levels of sticking tissue, and the thermographs showed that recorded highest temperature in liver tissue from the CrN-SS needle group was significantly lower than in the SS needle group. The total injury area of livers treated with CrN-SS needles was significantly lower than livers treated with SS needles at each time point. Moreover, the CrN-SS needles caused a relatively smaller area of lateral thermal injury, a smaller area of fibrotic tissue, and a faster process of hepatic remodeling in rat liver than the SS needles. Immunofluorescence staining and western blot analysis showed that rats treated with CrN-SS needles expressed lower levels of NF-κB and caspase-3 post-operatively. This study reveals that the plating of electrodes with a CrN film is an efficient method for improving the performance of electrosurgical units, and should benefit wound remodeling.

並列關鍵字

Electrosurgery ； Tissue sticking ； Thermal injury ； Chromium nitride

參考文獻

[1] Massarweh NN, Cosgriff N, Slakey DP. Electrosurgery: history, principles, and current and future uses. J Am CollSurg 2006;202:520-30.

[2] Song C, Tang B, Campbell PA, Cuschieri A. Thermal spread and heat absorbance differences between open and laparoscopic surgeries during energized dissections by electrosurgical instruments. SurgEndosc 2009;23:2480-7.

[3] Shamim M. Diathermy vs. scalpel skin incisions in general surgery: double-blind, randomized, clinical trial. World J Surg 2009;33:1594-9.

[4] Brown DB. Concepts, considerations, and concerns on the cutting edge of radiofrequency ablation. J VascIntervRadiol 2005;16:597-613.

[5] Brill AI. Bipolar electrosurgery: convention and innovation. ClinObstetGynecol 2008;51:153-8.