剪刀结合超声刀在非颈部切口内镜甲状腺手术中的应用

The clinical application of scissors combined with ultrasound knife in the operation of neck scarless endoscopic thyroidectomy

目的:探讨剪刀结合超声刀在非颈部切口内镜甲状腺手术中的可行性及优势。方法:回顾分析2006年10月至2010年10月492例患者行非颈部切口内镜甲状腺手术的临床资料。胸乳入路3孔法,采用单纯超声刀或剪刀结合超声刀的方式建立操作空间。结果:480例手术获得成功,12例中转开放手术。手术时间30～240 min,平均85 min。前期100例手术单纯使用超声刀建立颈部操作空间,暴露甲状腺时间15～36 min,平均20 min;后期392例使用剪刀结合超声刀完成手术空间游离,甲状腺暴露时间10～25 min,平均15 min。术中出血量平均10 ml。术后2～3 d拔除颈部引流管,3～5 d出院。无严重并发症发生,皮肤轻度烫伤1例。术后随访460例6～36个月,无甲状腺肿物复发,患者均满意。结论:剪刀结合超声刀在非颈部切口内镜甲状腺手术中建立操作空间快捷、方便、安全,且可延长超声刀使用寿命,值得推荐。

Objective：To discuss the feasibility and advantages of scissors combined with harmonic scalpel in the operation of neck scarless endoscopic thyroidectomy.Methods：A retrospective analysis was made on the clinical data of 492 patients in China-Japan Friendship Hospital,who underwent endoscopic thyroidectomy through anterior chest and breast approach between Oct.2006 and Oct.2010,with the establishment of perating space through the keen segregation of harmonic scalpel alone or combined with scissors.Results：480 cases of 492 operations were successfully performed.12 cases were converted to thyroidectomy.The operating time was 30-240 min（mean 50 min）.The time used to expose thyroid was 15-36 min（mean 20 min） in 100 patientis used harmonic scalpel,compared to the time of 10-25 min（mean 15 min） in 392 patients combined with scissors.The average introperative blood loss was 10 ml.The drainage tube was removed in 2-3 days and patients were discharged from the hospital in 3-5 days after operation.Only one case was found with slight scalded skin.There were no other complications.No recurrence was found in 460 cases after 6-36 months following up.All patients were satisfied with the cosmetic results.Conclusions：The application of scissors combined with harmonic scalpel to establish operating space in endoscopic thyroidectomy is speedy,convenient and safe with an extended life of harmonic scalpel,which is worthy of being recommended.