超声刀与传统方法在开放甲状腺手术的临床对比研究

Study on The Use of Harmonic Scalpel vs Conventional Knot Tying in Open Thyroid Surgery

目的比较超声刀开放甲状腺手术与传统甲状腺手术的优、缺点。方法设用超声刀行甲状腺手术151例为治疗组,传统甲状腺手术70例为对照组,均由同一手术组医生施术。分别比较2组的肿瘤直径、切口长度、总手术时间、切除甲状腺时间、术中出血量、术后引流量及手术并发症,同时比较治疗组在学习曲线中及学习曲线后的切口长度以及并发症。结果2组患者在性别、年龄、疾病构成以及肿瘤大小方面差异无统计学意义(P>0.05)。在相同术式中,治疗组的切口长度、总手术时间、切除甲状腺时间、术中出血量和术后引流量均少于对照组(P<0.001);2组的总体手术并发症差异无统计学意义(P>0.05);治疗组在学习曲线后的切口长度短于学习曲线中(P<0.05),在学习曲线后的并发症发生率低于学习曲线中(P<0.001)。结论用超声刀行开放甲状腺手术要优于传统方法甲状腺手术,但不能盲目使用超声刀,应该与传统丝线结扎手术方法有机结合。

Objective To compare the disadvantages and advantages of open thyroid surgery when using the harmonic scalpel （HS） vs conventional hemostasis （CH）. Methods One hundred and fifty-one patients and 70 patients underwent thyroid surgery with HS or CH respectively. The tumor diameter, incisional length, the total operative time, thyroidectomy time, intraoperative bleeding volume, postoperative drainage volume and surgical complications were compared. The incisional length and the surgical complications in and after learning curve with harmonic scalpel were compared. Results There was no significant difference between the HS and CH group at baseline. Incisional length, total operative time, thyroidectomy time, intraoperative bleeding volume and postoperative drainage volume in HS group were significantly lower than those of CH group （P〈0. 001）; the surgical complications showed no significant difference between the HS and CH group （P〉0.05） ; the incisional length after learning curve was shorter than that in learning curve in HS group （P〈0.05） ; the surgical complications after learning curve were significantly lower than that in learning curve in HS group （P〈0. 001）. Conclusion HS provides significant advantages over conventional hemostasis in open thyroid surgery. However, it can＇t be used in a blindly exclusive way but be combined with conventional knot tying appropriately.