| Objective:By comparing the effects of unipolar electrocoagulation with different power on the pathological injury of the porcine kidney during suture-free partial nephrectomy(SFPN),to provide a experimental basis for the application of unipolar electrocoagulation in SFPN.Methods: From January 2018 to July 2018,18 Guizhou miniature pigs were selected randomly,with an average age of 3 years and weight of 50 kg.According to whether the renal artery is blocked,divided into a blocking group and non-blocking group,with nine small pigs in each group.According to the different hemostatic power of unipolar electrocoagulation during open partial nephrectomy,each group was divided into three groups: 60 W subgroup,80 W subgroup and 100 W subgroup,with three heads in each subgroup.Take a parallel incision on the left side with the lumbosacral muscle.After the kidney was exposed,the blocking group clamped the left renal artery with an arterial clip.The renal tissue was removed at the middle pole of the left kidney,using unipolar electrocoagulation to stop bleeding until there was no bleeding in the kidney wound after loosening the arterial clip,and the renal artery clamping was blocked,The time is controlled at 20 min;There was no bleeding,and controlled the total blocking time of renal artery clamping at 20 min;in the non-blocking group,without blocking the renal artery,blood was sucked with a suction device while cutting and hemostasis was electrocoagulated with a unipolar electric hook.The renal tissue was resected about 2cm in both the blocking group and the non-blocking group and used unipolar electrocoagulation to stop bleeding.The power of each subgroup was 60 W,80W,and 100 W,respectively,until there was no bleeding in the kidney wound,and perirenal fat covered the kidney wound without suture.Close the incision on the kidney wound.During operation,we inserted a multi-channel thermometer probe into healthy kidney tissue at a distance of 2 mm,5 mm,and 10 mm from the unipolar electrocoagulation hook and away from the operation area,and recorded the temperature of each probe.Record the operation time,the amount of kidney bleeding,the time of hemostasis during the operation and the temperature of the left kidney.On the 7th day after the operation,take the kidneys for pathological examination,and the pathological changes of the kidneys were observed.Results: The operation of 18 pigs was completed.Observed seven days after the operation,all 18 pigs survived,the diet was normal,and their coat colour was shiny.No gross hematuria decreased urine output,and no blood was observed.When the hemostatic power was 60 W,80W and 100 W,the operation time of the blocking group was 41.4 ±5.6min,35.7 ±3.1min and 31.3 ±2.9min,respectively.The operation time in the non-blocking group was 45.3 ±2.1min,42.3 ±3.1min and 40.0 ±1.0min,respectively.The hemostatic time in the blocking group was 15.0 ±2.0min,10.7 ±1.5min and 6.5 ±0.9min,respectively.and the non-blocking group was 16.3±2.5 min and 11.0±2.6 min respectively And 7.7±0.6 min;the renal bleeding volume of the blocking group was 36.4±4.0 ml,21.5±4.8 ml and 15.3±4.5 ml respectively,and the renal bleeding volume of the non-blocking group was 52.3±1.5 ml,44.3±5.7 ml and 31.7±3.2 ml.In terms of the operation time,hemostasis time,and renal bleeding,both the blocking group and the non-blocking group were less than the 60 W subgroup in the 100 W subgroup and 80 W subgroup(P<0.05),and less than 80 W in the 100 W subgroup.Subgroup(P<0.05).When the hemostatic power was 60 W,the temperature at a distance from the electrocoagulation hook 10 mm,5mm and 2mm in the blocking group was 33.1 ±1.1 ?,36.9 ±4.1 ? and 41.9 ±3.9 ? respectively,and there was a significant difference between the two groups(P < 0.05).The temperature in the non-blocking group was 34.8±0.9°C,35.8±1.6°C,and 38.6±5.3°C,there was a statistically significant difference between the groups(P<0.05).When the hemostatic power is 80 W,the temperature of the blocking group at 10 mm,5mm and 2mm from the electrocoagulation hook is 33.9±1.0°C,38.6±2.4°C and 50.3±6.0°C.There is a statistically significant difference within the group;non-blocking The temperature of the group was 35.2±0.6°C,38.9±2.5°C and 51.3±6.0°C.There was statistical significance in the group(P<0.05).When the hemostatic power was 100 W,the temperatures at a distance from the electrocoagulation hooks 10 mm,5mm and 2mm in the blocking group were 34.6 ±0.3°C,41.7 ±1.3°C and 61.4 ±6.4°C,respectively.The difference between the groups is statistically significant(P< 0.05);The temperature in the non-blocking group was 35.5±0.8°C,41.7±1.1°C and 60.6±7.8°C,and the difference was statistically significant within the group(P<0.05).Under the same hemostatic power and the same distance from the electrocoagulation hook,there was no significant difference in temperature between the blocking group and the non-blocking group.When the hemostatic power was 60 W,80W,and 100 W,the total depth of pathological kidney damage in the blocking group was 7323±58?m,8119±98?m,and 8896±39?m,respectively.The total depth in the non-blocking group was 7330±435?m,8093±163?m and 8900±450?m respectively,100 W subgroup and 80 W subgroup are deeper than 60 W subgroup(P<0.05),100 W subgroup are deeper than 80 W subgroup(P<0.05).There was no significant difference in the total pathological damage depth between the blocking group and the non-blocking group at the same power(P>0.05).Conclusion: In SFPN,no matter whether the renal artery is blocked or not,the effect of using 60 W,80W,100 W power unipolar electrocoagulation on wound hemostasis is satisfactory;with the power of electrocoagulation Increased,hemostatic speed is faster,but the temperature of surrounding healthy pig kidney tissue(within 10 mm from the electrocoagulation hook)is higher,and the pathological damage is heavier;whether it is blocking the renal artery or not,the same power unipolar electrocoagulation has a considerable effect on the temperature distribution of the kidney and the degree of pathological damage. |
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