双极电凝镊在开放性甲状腺手术中的临床应用

Clinical Application of Bipolar Coagulation Forceps in Open Thyroid Operation

目的探讨双极电凝镊在开放甲状腺手术中应用的安全性和可行性,并总结相应的手术技巧。方法对南京大学医学院附属鼓楼医院2011年10月至2014年10月期间347例分别应用双极电凝镊和超声刀开展的开放性甲状腺手术患者的临床资料进行回顾性分析。结果 2组病例在手术时间、术中出血量、术后引流量和术后住院时间上的差异均无统计学意义(P>0.05);并发症方面,超声刀组的暂时性喉返神经麻痹及暂时性的甲状旁腺功能不足的发生率明显高于双极电凝镊组(P<0.05),而在气道压迫、永久性喉返神经和甲状旁腺损伤及喉上神经麻痹发生率方面2组间的差异无统计学意义(P>0.05)。结论用双极电凝镊行开放甲状腺手术是安全可行的,紧贴甲状腺被膜边凝边切并配合清楚直视下的精细分离是减少并发症的关键。

Objective To explore the feasibility and safety of clinical application of bipolar coagulation forceps in open thyroid operations and summarize the operation skill. Methods The clinical data of 347 cases performed thyroid operations with bipolar coagulation forceps and Harmonic scalpel respectively from October 2010 to October 2014 in our hospital were analyzed retrospectively. Results No statistical differences was found on the operative time, intraoperative bleeding, postoperative drainage, and postoperative hospitalization of the two groups （P〉0.05）. The complications of transient palsy of recurrent laryngeal nerve and transient functional insufficiency of parathyroid were more in Harmonic scalpel group than in bipolar coagulation forceps group with statistical difference （P〈0.05）. But there was no difference of the complications of airway obstruction, permanent injuries of recurrent laryngeal nerve, parathyroid and superior laryngeal nerve in the two groups （P〉0.05）. Conclusions Thyroid operations with bipolar coagulation forceps are safe and feasible. Coagulation tightly along the thyroid capsule followed by incision with explicit subtle dissection is the key point of the decrease of complications.