超声刀在甲状腺手术中的应用

Thyroidectomy with harmonic scalpel

目的探讨超声刀在甲状腺手术的效果。方法对收治的34例甲状腺肿物采用超声刀手术,通过颈部小切口进行甲状腺肿物摘除术或腺叶切除术。采用病例对照研究方法,随机选取常规手术的34例患者为对照组。比较两组的切口长度、引流情况、并发症、住院费用、麻醉时间和出院时间等指标。结果超声刀组切口长3.2cm～4.3cm,平均3.8cm。比对照组平均减少3.2cm(t=17.65,P=0.000)。超声刀组患者伤口内不放置引流,对照组平均引流液47(10～110)ml。两组平均住院费用(7205元对比8054元)和出院时间(3.5天对比4.1天)统计学上差异无显著性(P=0.137和P=0.228)。超声刀组手术麻醉时间95分钟,比对照组延长了14分钟(P=0.018)。两组各有1例出现喉返神经麻痹症状,超声刀组有2例患者发生表皮轻微烫伤(x2=0.273,P=0.602)。两组患者术后均无伤口出血、积液、感染以及低钙血症等并发症。结论超声刀甲状腺手术不增加手术并发症。患者的颈部切口小,有利于美观。超声刀凝血功能强,避免了放置引流,且伤口内无线头遗留,手术创伤小,有利于患者的恢复。

OBJECTIVE To evaluate the benefits,if any, of thyroidectomy using the harmonic scalpel versus conventional thyroidectomy. METHODS The clinical data of 34 consecutive patients underwent thyroid nodule enucleation or Iobectomy in one year using the harmonic scalpel were recorded. The results were compared with that of the 34 case-control patients in the same period using conventional techniques. RESULTS The average incision length for those underwent thyroidectomy with the harmonic scalpel and conventional techniques was 3.8cm and 6.9cm respectively. Drains were not used in the harmonic scalpel group compared with average of 47ml drainage in the control group. The average inpatient cost was 7205 RMB for the harmonic scalpel group versus 8054 RMB for the control group（P=0.137）. The average postoperative length of hospitalization was 3.5 days for the harmonic scalpel group versus 4.1 days for the control group （P=0.228）. The average time of anesthesia was 95 minutes for the harmonic scalpel group compare with 81 minutes for the control group （P=0.018）. One postoperative hoarseness occurred in each group. Two patients had mild skin burn in the harmonic scalpel group. No other complications were enumerated（x^2=0.273,P=0.602）. CONCLUSION The harmonic scalpel is a safe alternative for thyroidectomy. Compare with conventional thyroid surgery, this technique offers cosmetic benefit and less trauma for patient with thyroid nodules.