This is an instrument that uses high-frequency current to sharply cut (incise) tissue without applying pressure to it, and closes (coagulates) small blood vessels and capillaries, allowing surgery without bleeding (minimal bleeding). It is also called an electrosurgical instrument. It consists of a high-frequency current generator, a metal part that derives this current and passes it through the living body, and a counter electrode plate that collects the current from the living body. Incisions are made by utilizing the explosive vaporization of water in the tissue caused by the high-frequency current, and coagulation is achieved by coagulating the proteins in the tissue components with Joule heat generated in the tissue, which results in a hemostatic effect. In reality, both effects are mixed, allowing incisions to be made while stopping bleeding. It has also been discovered that the coagulation process involves an electrical discharge phenomenon (spark coagulation). Electric scalpels are widely used in surgeries, including those performed in neurosurgery, such as for scalp incisions and coagulation and hemostasis of small bleeding spots, in thoracic surgery, such as for lung resections, and in gastrointestinal surgery, such as for incision and amputation of the digestive tract. Damage caused by electric scalpels includes burns, electric shock, induction interference, radio interference, and explosions. High-frequency current has the tendency to flow in ways other than the normal path, and can cause burns in unexpected areas (protruding parts of the body that come into close contact with the operating table, such as the head, scapular region, and lower back). It is desirable to prevent this by using the correct return electrode and by using an electric scalpel with an insulated output circuit that is less likely to cause high-frequency shunting. To prevent electric shock, it is advisable to ensure that the electric scalpel is properly earthed, and to strictly manage safety (such as a start-of-shift inspection using a checklist and regular inspections every three months) to prevent general injuries. Incidentally, electric scalpels were developed to compensate for the shortcomings of conventional mechanical blade scalpels, but recently other scalpels that have the same purpose of simultaneously performing incisions and hemostasis include the laser scalpel, ultrasonic scalpel, and freezing scalpel. [Kunio Okajima] Source: Shogakukan Encyclopedia Nipponica About Encyclopedia Nipponica Information | Legend |
高周波電流を用いて、組織に圧力を加えずにこれを鋭利に切離(切開)するとともに、細小血管や毛細管を閉鎖(凝固)することによって出血させない(少ない出血)で手術ができる機器をいい、電気手術器ともよばれる。高周波電流発生装置と、これを導出して生体に通電する金属部、および生体から電流を回収する対極板からなる。切開は高周波電流によって組織中の水分が爆発的に水蒸気化することを利用して行い、凝固は組織内に発生するジュール熱により組織成分のタンパク質を凝固させるわけで、これにより止血作用が生ずる。実際には両作用が混合し、止血しながら切開することができる。なお、凝固には放電現象(火花凝固)も加わっていることがわかってきた。 電気メスによる手術は、頭皮の切開や小出血点の凝固止血など脳神経外科領域、肺切除など胸部外科領域、消化管の切開や切断など消化器外科領域などでしばしば行われ、電気メスが広く使われている。 電気メスによる障害としては、熱傷をはじめ、電撃、誘導障害、電波障害、爆発などがあげられる。高周波電流は正常の経路以外を流れやすい性質があり、思わぬ部位(頭部、肩甲部、腰部など身体の凸部で手術台と密着する部位)に熱傷を生ずることがある。対極板を正しく使用するとともに、高周波分流がおこりにくい絶縁型出力回路をもった電気メスを使って防止することが望まれる。電撃に対しては電気メスのアースを確実にとること、また全般の障害防止に対して保安管理(チェックリストによる始業点検や3か月ごとの定期点検など)を厳重に行うことが望まれる。 なお、電気メスは通常の機械刃メスの欠点を補うために登場してきたわけであるが、同様に切開と止血を同時に行う目的をもったメスとしては、最近、レーザーメス、超音波メス、冷凍メスなどが登場してきた。 [岡島邦雄] 出典 小学館 日本大百科全書(ニッポニカ)日本大百科全書(ニッポニカ)について 情報 | 凡例 |
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