甲状腺精细化被膜解剖技术中超声刀的应用体会

Application of harmonic scalpel combined with meticulous capsular dissection technique in thyroidectomy

目的探讨甲状腺精细化被膜解剖技术中超声刀的应用体会，分析其安全性和疗效。方法选择应用超声刀对血管进行骨骼化为核心的精细化被膜解剖技术的甲状腺手术患者135例（超声刀组），并选择应用传统手术器械的精细化被膜解剖技术的甲状腺手术患者140例（传统组）。观察比较两组的腺体切除时间、术中出血量、术后引流量及术后并发症发生情况。结果两组患者均痊愈出院。超声刀组甲状腺全切除术、甲状腺次全切除术患者腺体切除时间分别为（50．0±6．9）、（39．9±6．6）min，均短于传统组的（82．0±14．4）、（73．1±14．5）min；超声刀组甲状腺全切除术、甲状腺次全切除术患者术中出血量分别为（18．7±10．9）、（17．7±9．3）ml，均少于传统组的（41．9±15．6）、（42．2±14．6）ml；超声刀组甲状腺全切除术、甲状腺次全切除术患者术后引流量分别为（40．7±11．7）、（42．7±14．5）ml，均少于传统组的（53．9±17．5）、（61．8±22．9）ml，差异均有统计学意义（P〈0．01）。两组术后暂时性甲状旁腺功能低下、暂时性喉返神经麻痹发生情况比较差异无统计学意义（P〉0．05）。结论精细化被膜解剖技术的甲状腺手术中应用超声刀安全、可靠，具有手术时间、术中出血量、术后引流量明显减少的优势，可在临床中推广应用。

Objective To introduce the clinical experience and investigate the significance and safety of harmonic scalpel combined with meticulous capsular dissection technique in thyroidectomy. Methods A retrospective analysis was performed on 275 patients who underwent thyroidectomy among which 135 patients were treated by capsular dissection technique and harmonic scalpel （harmonic scalpel group ）, the other 140 patients were treated by electric knife and traditional ligation （traditional group）. The thyroidectomy operative time, intraoperative bleeding volume, postoperative drainage volume and surgical complications were compared between two groups. Results In harmonic scalpel group, the thyroidectomy operative time of total thyroidectomy and subtotal thyroidectomy was significantly shorter than that in traditional group [ （50.0±6.9 ） min vs. （82.0 ±14.4 ） min, （39.9 ± 6.6 ） min vs. （73.1± 14.5 ） min （P 〈 0.01 ）. The intraoperative bleeding volume of total thyroidectomy and subtotal thyroidectomy in harmonic scalpel group was significantly lower than that in traditional group [ （ 18.7± 10.9） ml vs. （41.9± 15.6） ml, （ 17.7± 9.3 ） ml vs. （42.2 ±1 4.6 ） ml ] （P 〈 0.01 ）. The postoperative drainage volume of total thyroideetomy and subtotal thyroidectomy in harmonic scalpel group was significantly lower than that in traditional group [ （40.7±11.7） ml vs. （53.9±17.5） ml, （42.7±14.5） ml vs. （61.8±22.9） ml] （P 〈 0.01 ）.The rate of temporary hypoparathyroidism and temporary recurrent laryngeal nerve palsy had no significant difference between two groups （P 〉 0.05 ）. Conclusions Application of harmonic scalpel combined with meticulous capsular dissection technique in thyroidectomy can significantly reduce thyroidectomy operative time, intraopemtive bleeding volume, postoperative drainage volume and surgical complications. Harmonic scalpel combined with meticulous capsular dissection technique in thyroidectomy should be widely used.