麻醉膨胀液在腔镜辅助甲状腺微小癌手术中的应用

Application of Anesthesia Expansion Fluid in Endoscopic-assisted Surgery for Thyroid Microcarcinoma

目的探讨腔镜辅助甲状腺微小癌手术中应用麻醉膨胀液的效果。方法选择2015年1月~2018年6月甲状腺微小癌120例,随机分为观察组和对照组各60例,均行腔镜辅助甲状腺手术,观察组提起腺体暴露喉返神经时沿甲状腺真假被膜平行注射麻醉膨胀液(生理盐水250ml+2%利多卡因10ml+5%碳酸氢钠5ml)10ml,对照组未注射麻醉膨胀液。比较2组手术时间、术中出血量、淋巴结清扫数、术后3天总引流量、术后出血、声音嘶哑和甲状旁腺损伤发生率。结果与对照组相比,观察组手术时间短[(61.5±9.0)minvs.(66.5±7.0)min,t=-3.385,P=0.001],术中出血少[中位数27(15~33)mlvs.29(20~45)ml,Z=-2.682,P=0.007],清扫淋巴结多[6(4~9)枚vs.5.5(2~9)枚,Z=-2.910,P=0.004],术后引流量少[59(49~75)mlvs.70(40~85)ml,Z=-5.448,P=0.000],术后声音嘶哑少(1例vs.8例,χ^2=4.324,P=0.038),术后出血少(2例vs.9例,χ^2=4.904,P=0.027)。2组均无甲状旁腺损伤。结论腔镜辅助甲状腺微小癌手术中应用麻醉膨胀液是安全的,可明显减少并发症。

Objective To explore the effect of anesthetic expand fluid in endoscopic-assisted thyroidectomy for thyroid microcarcinoma.Methods A total of 120 cases of thyroid microcarcinoma from January 2015 to June 2018 were randomly divided into observation group or control group,with 60 cases in each group.All the patients underwent endoscopic thyroidectomy.The observation group received parallel injection of anesthetic expansive fluid (normal saline 250 ml + 2% lidocaine 10 ml + 5% sodium bicarbonate 5 ml) for 10 ml along the true and false membrane of thyroid when the glands were exposed to recurrent laryngeal nerve.The control group received no injection of anesthesia expansive fluid.The operation time,intraoperative blood loss,number of lymph node dissection,total drainage volume in 3 days after operation,and incidence of bleeding after operation,hoarseness and parathyroid injury were compared between the two groups.Results The observation group had shorter operative time [(61.5±9.0) min vs.(66.5±7.0) min,t =-3.385,P =0.001],less intraoperative bleeding [27 (15-33) ml vs.29 (20-45) ml,Z =-2.682,P = 0.007],more lymph nodes [6 (4-9) vs.5.5 (2-9) nodes,Z =-2.910,P =0.004],less drainage volume [59 (49-75) ml vs.70 (40-85) ml,Z =-5.448,P =0.000],less hoarseness after surgery (1 case vs.8 cases,χ^2 =4.324,P = 0.038),less bleeding after operation (2 cases vs.9 cases,χ^2 =4.904,P =0.027) than the control group.There was no parathyroid injury in both groups.Conclusion The application of anesthetic expansion fluid in endoscopic-assisted thyroidectomy for thyroid microcarcinoma is safe and significantly reduces complications.