摘要： 目的 报告双极电凝模式用于脑血管重建术分离供体动脉的体验，探讨其与传统分离技术的差异。方法与结果 手术器械包括呈双极输出的高频电刀［电凝功率60~70 W（分离）或4~8 W （止血）］、短双极电凝镊（体长12 cm、尖端直径< 0.50 mm并涂抹超强抗粘涂层）和短微型吸引器头（长15 cm、直径0.50 mm）。标记颞浅动脉走行，依据术式划定切口（以不损伤颞浅动脉根部为宜）；固定皮瓣，电凝镊（功率70 W）尖端由动脉根部分离、离断浅层和周围组织，显露动脉，以食指末端反复核对血管搏动性和走行；缝线打结并离断动脉末端，预留一段较长缝线。术者一手持蚊式钳夹缝线，轻拉予血管抬离皮瓣的张力，另一手继续以电凝镊分离血管深面组织、离断沿途小分支，操作过程中电凝镊不得触碰血管；全程保持动脉湿润，维持舒张状态，血管痉挛者可以法舒地尔湿棉片包裹供体动脉，使其快速扩张。结论 完整分离供体动脉、保证桥血管血流通畅是脑血管重建术获得成功的首要条件，与传统分离技术相比，双极电凝模式采用头端尖锐的高功率短双极电凝镊，不仅分离效率高、安全性良好、对皮瓣损伤小，且所获桥血管有效长度更长、顺应性更佳。为避免电凝镊产生的热能波及损伤目标动脉，分离过程中镊尖务必与血管保持安全距离，可留有少量软组织附着于血管；若供体动脉或其小分支断端出血，可调整电凝功率至6 W，镊尖轻触出血点止血。双极电凝分离血管对术者技术水平要求较高，需反复练习方可进行实际操作。

关键词: 电凝术, 脑血管重建术, 颞动脉

Abstract: Objective To report the first application of bipolar coagulation in separating donor vessels of surgical revascularization and explore the differences with traditional separated techniques. Methods and Results Instruments included high-frequency electrosurgical electric knife with bipolar mode[electric coagulation energy 60-70 W (separation) or 4-8 W (hemostasis)], short bipolar forceps (body length was 12 cm and its tips was coated with strong anti-stick coating, of which diameter was < 0.50 mm) and a short microaspirator tip (its length was 15 cm with 0.50 mm diameter). Initially, the shape of superficial temporal artery (STA) was marked and an incision was made based on surgical types from damaging the root of STA. Following with the fixed flap, bipolar tweezers were employed to separate the artery with 70 W of electric energy. And in this procedure, the arterial pulse and walking was verified by fingers. Afterwards, the surgeon separated donor arteries from the deep connective tissue by short bipolar forceps with lifting vessels away from the flap on the other hand. Of notes, bipolar forceps should avoid direct contact with vessels and the maintain of moist arterial staus also requires in the whole process. In addition, cotton tablets which were soked with fasudil could wrap the donors for rapid angiectasis just in case of strong vasospasm. Conclusions The quality of donor vessels is a primary factor determining the success of cerebral revascularization. In contrast with the traditional separated techniques, short tweezers were applied in the separation of donor vessels with sharp tips, favorable safety, little damages, high power of electrocoagulation and efficiency. Besides, the length of arteries harvested by bipolar coagulation was longer than that by monopolar coagulation, so did with the vascular compliance. Precise coagulation should be applied at a certain distance from targeted blood vessels and a proper amount of soft tissues could be attached to vessels. Once donor arteries or these branches were bleeding, bipolar tips could be employed in the hemorrhagic sites with 6 W of the electric coagulation power softly. Meanwhile, the techniques in the separation of blood vessels by bipolar forceps required high surgical abilities which called for practices.

Key words: Electrocoagulation, Cerebral revascularization, Temporal arteries