水动力清创系统在离体猪皮烧伤创面模型削痂与清创中的应用效果

潘选良; 陈炯; 韩春茂; 王新刚

doi:10.3760/cma.j.cn501225-20250327-00146

水动力清创系统在离体猪皮烧伤创面模型削痂与清创中的应用效果

doi: 10.3760/cma.j.cn501225-20250327-00146

潘选良^{1, 2},
陈炯^3, ,,
韩春茂¹,
王新刚¹

1.
浙江大学医学院附属第二医院烧伤与创面修复科,杭州　310009
2.
龙泉产业创新研究院,龙泉　323700
3.
温州医科大学附属第三医院烧伤与皮肤修复外科,瑞安　325200

基金项目:

国家自然科学基金青年科学基金项目 82402900

详细信息

通讯作者:
陈炯,Email：2008chenjiong@163.com

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出版历程
- 收稿日期: 2025-03-27
- 网络出版日期: 2026-08-13

Application effects of the hydrosurgical debridement system in ex vivo porcine burn skin models of eschar excision and debridement

1.
Department of Burn and Wound Repair, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
2.
Longquan Industrial Innovation Research Institute, Longquan 323700, China
3.
Department of Burn and Skin Repair Surgery, the Third Affiliated Hospital of Wenzhou Medical University, Ruian 325200, China

Funds:

Young Scientists Fund of National Natural Science Foundation of China 82402900

More Information

Corresponding author: Chen Jiong, Email: 2008chenjiong@163.com

摘要

摘要: 目的探讨水动力清创系统（以下简称水刀）在离体猪皮烧伤创面模型削痂与清创中的应用效果。方法该研究为成组设计的基础研究。2024年11月21日,浙江省23名青年医师（男20名、女3名,年龄30~43岁）于宁波市参加2024年浙江省烧伤外科临床技能比赛,每名医师分别使用水刀与传统器械,对离体猪皮烧伤早期焦痂创面模型和后期溶痂创面模型（面积均为12 cm×8 cm）分别实施削痂手术（应用水刀和辊轴取皮刀）与清创手术（应用水刀和常规手术刀）。记录两种手术中应用两种操作器械的耗时（评估速度）及清除组织量（评估精准度）。结果在削痂手术中,水刀操作耗时[122（96,145）s]与传统器械[125（56,233）s]相比,差异无统计学意义（P>0.05）；水刀清除组织量为（2.88±0.27）g,显著少于传统器械的（13.81±1.93）g,（t=-5.44,P<0.05）。在清创手术中,水刀操作耗时为（121±9）s,显著短于传统器械的（368±33）s,（t=-7.00,P<0.05）；水刀清除组织量为（30.85±1.98）g,显著多于传统器械的（21.48±1.45）g,P<0.05。结论与传统器械相比,水刀在离体猪皮烧伤创面早期削痂手术中可更精准地清除坏死组织,减轻对正常组织的损伤；但在后期清创手术中虽显著提高清创速度,却可能清除过多正常组织。
- 烧伤 /
- 外科手术 /
- 模型,动物 /
- 清创术 /
- 削痂 /
- 水动力清创系统 /
Abstract: Objective To investigate the application effects of the hydrosurgical debridement system (hereinafter referred to as the water jet) in ex vivo porcine burn skin models of eschar excision and debridement. Methods This was a grouped basic research study.Twenty-three young physicians (20 males, 3 females, aged 30-43 years) participated in the 2024 Zhejiang Provincial Burn Surgery Skills Competition. Each physician performed eschar excision and debridement procedures using both the water jet and conventional instruments (a dermatome and a scalpel) in ex vivo porcine burn skin models of early-stage eschar excision and late-stage debridement of liquefied eschar (each measuring 12 cm×8 cm). The operation time (assessing speed) and weight of removed tissue (assessing precision) were recorded for both techniques in both procedures. Results In escharectomy procedures, the operative time of the water jet (122 (96, 145) s) showed no significant difference compared with conventional instruments (125 (56, 233) s), P>0.05; however, the tissue removal weight of the water jet (2.88±0.27) g was significantly less than (13.81±1.93) g of conventional instruments (P<0.05). In debridement procedures, the operative time of the water jet (121±9) s was significantly shorter than (368±33) s of conventional instruments (P<0.05); however, the tissue removal weight of the water jet (30.85±1.98) g was significantly greater than (21.48±1.45) g of conventional instruments (P<0.05). Conclusions Compared with conventional instruments, the water jet can remove necrotic tissue in ex vivo porcine burn skin more precisely and reduce damage to healthy tissue in early-stage eschar excision; however, in late-stage debridement of liquefied eschar, although it significantly improves debridement speed, it may remove excessive normal tissue.
- Burns /
- Surgical procedures, operative /
- Models, animal /
- Debridement /
- Tangential excision /
- Hydrosurgery system /
- Wound repair
潘选良：设计研究、实施研究、收集与分析数据、撰写文章；陈炯：设计试验、实施研究、修改文章、对文章的知识性内容作批评性审阅；韩春茂、王新刚：实施并指导研究、对文章的知识性内容作批评性审阅

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图 1 两种离体猪皮烧伤模型。1A.早期焦痂创面模型；1B.后期溶痂创面模型

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图 2 两种操作器械处理离体猪皮烧伤早期焦痂创面模型。2A.用辊轴取皮刀削痂；2B.用水动力清创系统削痂

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图 3 两种操作器械处理离体猪皮烧伤后期溶痂创面模型。3A.用常规手术刀清创；3B.用水动力清创系统清创

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Table 1. 两种操作器械在削痂手术及清创手术中耗时与清除组织量比较

操作器械	样本数	削痂手术		清创手术
操作器械	样本数	耗时[s,M（Q₁,Q₃）]	清除组织量（g,x¯±s）	耗时（s,x¯±s）	清除组织量（g,x¯±s）
水动力清创系统	23	122（96,145）	2.88±0.27	121±9	30.85±1.98
传统器械	23	125（56,233）	13.81±1.93	368±33	21.48±1.45
统计量值		Z=1.00	t=-5.44	t=-7.00	t=4.00
P值		0.319	<0.001	<0.001	0.001
注：削痂用的传统器械为辊轴取皮刀,清创用的传统器械为常规手术刀