钳式超声刀辅助与传统方式（电刀）甲状腺切除术手术并发症的比较研究

Comparative study on complication between clamp harmonic scalpel and bipolar electric knife in open thyroidectomy

目的比较钳式超声刀辅助下与传统方式即电刀下的甲状腺切除术手术并发症发生率。方法回顾性分析中山大学附属孙逸仙纪念医院甲状腺外科2009年1月至2010年12月行开放甲状腺切除术病例，根据其手术辅助方式分为钳式超声刀组633例及电刀组587例，比较术中、术后出血量，术后再次手术止血率，术后暂时性、迟发性及永久性声音嘶哑，术后暂时性及永久性甲状旁腺功能低下及术后伤口感染发生率。结果电刀组与钳式超声刀组的术中出血量、术后出血量、术后再次手术止血率、术后暂时性、迟发性声音嘶哑、术后暂时性甲状旁腺功能低下等并发症显著降低，数据依次为：（21．0±0．7）mlVS（10．0±0．30）ml，（31．0±1．1）mlVS（12．0±1．4）ml，1．53％VS0．47％，2．39％VS0．95％，1．87％VS0．63％，3．58％VS1．73％，差异有统计学意义（P〈0．05）；而2组的永久性喉返神经损伤性声音嘶哑、永久性甲状旁腺功能低下及术后伤口感染发生率数据依次为：0％VSO％，0％VS0％，0．68％VS0．63％，差异无统计学意义（P〉0．05）。结论与传统电刀辅助的甲状腺切除术相比较，钳式超声刀辅助下的甲状腺切除术并发症显著降低，是一种更安全的手术方式。

Objective To compare complication between clamp harmonic scalpel and traditional pattern of bipolar electric knife in open thyroidectomy. Methods Patients undergoing open tbyroidectomy from Jan. 2009 to Dec. 2010 in Thyroid Surgery Department of Sun Yat-sen Memorial Hospital of Sun Yat-sen University were analyzed retrospectively. Patients fell into 2 groups according to operative pattern： 633 cases in clamp harmonic scalpel group and 587 eases in bipolar electric knife group. Complications such as intraoperative and postoperative blood loss, reooperative hemostatic rate, transient or permanent recurrent laryngeal nerve palsy, transient or permanent hypoealeaemia, and infection rate were compared. Results Compared with bipolar electric knife group, intraoperative and postoperative blood loss, reoperative hemostatic rate, transient recurrent laryngeal nerve palsy and transient hypocaleaemia in clamp harmonic scalpel group were significantly lower： （21.0 ± 0.7 ） mlvs （10.0±0.3） ml, （31.0±1.1） mlvs （12.0±1.4） ml, 1.53% vs0.47%,2.39% vs0.95%, 1.87% vs 0. 63% , and 3.58% vs 1.73% respectively（P 〈 0. 05）. There was no significant difference in complications of permanent hypoealcaemia, permanent recurrent laryngeal nerve palsy and infection rate for the 2 groups： 0% vs 0% , 0% vs 0% , and 0. 68% vs 0. 63% respectively（P 〉 0. 05）. Conclusions Compared with traditional pattern of thyroideetomy, complication rate in clamp harmonic scalpel is significantly lower. Thyroidectomy by clamp harmonic scalpel is a safer operative pattern and worth to be popularized.