各種経尿道的手術用電極の特性の検討

Abstract

豚筋肉を用い, 実際の手術になるべく近い条件で実験を行い, 切除切片重量, 切除+蒸散層の深さ, 乾燥凝固層の深さを測定した.更に, それをもとに各種電極の分類を試み, 各々の適正な出力, ストローク速度を検討した.蒸散量から, 4種類の電極は, 蒸散, 蒸散切除, new TURの三つのカテゴリーに分類できた.出力を上げると, 蒸散では切除+蒸散層, 乾燥凝固層とも深くなった.蒸散切除では, 切除+蒸散層は深くなり, 乾燥凝固層は深くなる傾向を認めた.new TURでは, どちらにも変化を認めなかった.ストローク速度を速くすると, 蒸散切除では, 切除+蒸散層, 乾燥凝固層とも浅くなった.new TURでは, 乾燥凝固層のみ浅くなった.適正な出力, ストローク速度は, 蒸散は240W, 0.6cm/秒以下, 蒸散切除は220～240W, 0.6cm/秒, new TURは200W, 1.2cm/秒と考えられた

The characteristics of four electrodes for transurethral surgery were examined by resection experiments using porcine muscles. The electrodes were a loop type (uroloop, ENDO care), a roller type (STORZ), VAPOR CUT (STORZ) and WEDGE (Microvasive Co). With the stroke rate fixed at 1.2 cm/second and the electrical output changed to 200, 220, 240 W, the electrode was moved manually by 1 stroke for resection. Sections were weighed, histological changes on the cut surface were observed under a microscope and the excised + vaporized layer and desiccated layer were measured. A similar study was also made with the electrical output fixed at 200 W and the stroke rate changed to 0.6, 1.2, 2.4 cm/second. When the output was increased, the excised + vaporized layer and desiccated layer became deep with the roller-type. The excised + vaporized layer became deep and the desiccated layer tended to become deep with the UROLOOP and VAPOR CUT. No change in either layer was found with WEDGE. When the stroke rate was increased, both excised + vaporized layer and desiccated layer became shallow with VAPOR CUT, but only the desiccated layer became shallow with WEDGE. In conclusion, the proper output and stroke rate were considered to be 240 W and not more than 0.6 cm/second with the roller-type, 220-240 W and 0.6 cm/second with VAPOR CUT and 200 W and 1.2 cm/second with WEDGE.