摘要
目的探讨腔镜甲状腺术后迟发出血的原因及其预防措施。方法对2002年3月~2010年4月暨南大学附属第一医院微创外科中心采用胸乳入路施行腔镜甲状腺腺叶切除手术1600例患者中出现迟发性出血的2例患者进行原因及处理方法分析。结果 2例发生迟发性出血的患者中,1例甲状腺次全切除术后第4天甲状腺创面小动脉出血,1例甲状腺近全切除术后第9天在情绪激动大声讲话时甲状腺上动脉出血。2例均需急诊手术再次探查,明确病因。采用缝扎或结扎止血,均取得满意止血效果,术后无再发出血。结论术者熟悉甲状腺及其毗邻的局部解剖关系,正确使用超声刀,术中仔细凝固切断血管、彻底止血;患者术后半个月内尽量食用温凉、易吞咽的食物,少大声说话,避免用力咳嗽、颈部剧烈活动,卧床休息是预防术后迟发出血的关键。
[Objective] To investigate the causes and prevention of delayed post-operative hemorrhage after laparoscopic thyroidectomy via breast approach.[Methods] From March 2002 to April 2010,laparoscopic thyroidectomy were performed on 1600 patients.2 of the patients happened delayed hemorrhage after the surgery.These two cases were reviewed and analyzed for the causes of delayed post-operative hemorrhage and the possible prevention for it.[Results] There were two cases of delayed post-operative hemorrhage.1 patient received laparoscopic subtotal thyroidectomy and small arterial bleeding happened 4 days after the surgery.Another patient received laparoscopic near-total thyroidectomy and the post-operative hemorrhage happened 9 days after the surgery while the patient was loudly speaking.These two cases required emergency surgery.Result of surgical hemostasis,achieved by suturing and ligation,were both satisfying.[Conclusions] Surgeons must be familiar with the surgical anatomy of the thyroid region,and the hemostatic effect by using harmonic scalpel.One should be cautious while sealing the vessels with harmonic scalpel,adequate hemostasis should be achieved.Two weeks after the surgery,patients should be advised to ingest food which is not too hot and could be easily swallowed.Loud speaking and consistent coughing as well as vigorous movement of the neck should be avoided.Bed rest is critical for prevention of delayed post-operative hemorrhage.
出处
《中国内镜杂志》
CSCD
北大核心
2011年第6期594-596,共3页
China Journal of Endoscopy
关键词
甲状腺切除术
腹腔镜
胸乳入路
迟发出血
thyroidectomy
laparoscopy
breast approach
delayed hemorrhage