结合超声刀的精细化解剖技术在甲状腺外科中的应用

Clinical application of meticulous dissection technique combined with harmonic scalpel in thyroid surgery

目的总结超声刀联合甲状腺精细化解剖技术在甲状腺手术中的应用体会,分析其安全性和疗效。方法2010年7月至2015年12月,采用超声刀联合甲状腺精细化解剖技术治疗甲状腺疾病患者333例。本文对本组患者进行回顾性分析,评估术后出血、低钙血症及喉返神经麻痹等并发症的发生概率。结果所有患者中,实施甲状腺全/次全切除57例,单侧腺叶切除276例。其中发生术后出血2例,暂时性甲状旁腺功能低下3例,暂时性喉返神经麻痹1例,均经相应处理痊愈出院。结论结合超声刀的甲状腺精细化解剖技术,能较好地原位保留甲状旁腺及其血供,避免喉返神经损伤。该技术安全可靠,值得临床推广应用。

Objective To sum up the clinical experience with the application of meticulous dissection technique combined with harmonic scalpel in thyroid surgery to analyzed the safety and efficacy of this kind of surgical procedure. Methods A retrospective analysis was carried out among 333 patients with thyroid lesions undergone thyroidectomy by meticulous dissection technique combined with the application of harmonic scalpel, treated in our Hospital from Jul., 2010 to Dec., 2015. A careful analysis was made to investigate the occurrence of such operating associated complications as post-operative bleeding, hypocalcaemia, and laryngeal nerve palsy to evaluate the safety and efficacy of the operation. Results Of these 333 cases, 57 received total/subtotal thyroidectomy,276 undergone single side of thyroid lobectomy. In this group of cases, postoperative bleeding occurred in 2 cases, hypocalcemia taken place in 3, and temporary recurrent laryngeal nerve palsy seen only in 1, with their complicated conditions recovered completely following appropriated treatment to leave hospital. Conclusions Meticulous dissection technique combined with the application of harmonic scalpel can keep the parathyroid glands and their blood supply well in situ, avoid damage to the recurrent laryngeal nerve from occurring and reduce the risk of other operating associated complications taking place during thyroid surgery.Therefore, it is safe and worthy of promotion to wider clinical use.