微创钨针在开放性甲状腺手术中喉返神经和甲状旁腺保护的临床应用

Microdissection tungsten needle in protecting recurrent laryngeal nerve and parathyroid gland in open thyroid surgery

目的比较微创钨针和高频电刀在开放性甲状腺手术中的临床应用效果。方法选取陆军军医大学大坪医院乳腺甲状腺外科2017年1月至2017年12月接受开放性甲状腺手术的95例为研究对象,根据方法不同将其分为微创钨针组(n=50)和高频电刀组(n=45),比较两组的手术时间、术中出血量、术后引流量、术后并发症发生率和复发转移率。结果微创钨针组和高频电刀组在手术时间[(79.3±14.7 vs 73.7±13.9)min,t=1.914,P=0.059]、术中出血量[(31.8±9.7 vs 30.3±10.6)ml,t=0.702,P=0.484]、术后引流量[(67.3±13.0 vs 71.3±10.8)ml,t=-1.650,P=0.102]比较差异无统计学意义(P>0.05)。微创钨针组暂时性喉返神经损伤(2%vs 17.8%,χ^2=5.518,P=0.023)和暂时性甲状旁腺功能低下(18%vs 44%,χ^2=7.810,P=0.005)发生率低于高频电刀组,差异有统计学意义(P<0.05)。两组均无永久性喉返神经损伤和甲状旁腺功能低下,随访期内无复发转移。结论微创钨针在开放性甲状腺手术中对喉返神经和甲状旁腺功能保护效果优于高频电刀,值得临床推广应用。

Objective To compare the therapeutic effects of microdissection tungsten needle and high-frequency electrosurgical generator on open thyroid surgery.Methods 95 patients who underwent open thyroid surgery from Jan.2017 to Dec.2017 in the Department of Breast and Thyroid Surgery,Daping Hospital of Army Military Medical University were divided into microdissection tungsten needle group(n=50)and high-frequency electrosurgical generator group(n=45)according to different methods.The operation time,intraoperative blood loss,postoperative drainage volume,postoperative complication rate and recurrence and metastasis rate of the two groups were compared.Results There were no significant differences in operation time(79.3±14.7 vs 73.7±13.9,t=1.914,P=0.059),intraoperative blood loss(31.8±9.7 vs 30.3±10.6,t=0.702,P=0.484)and postoperative drainage volume(67.3±13.0 vs 71.3±10.8,t=-1.650,P=0.102)between the two groups(P>0.05).There were significant differences between the two groups in temporary recurrent laryngeal nerve(RLN)injury(2%vs 17.8%,χ^2=5.518,P=0.023)and temporary hypoparathyroidism(18%vs 44%,χ^2=7.810,P=0.005),and the results of the microdissection tungsten needle group were better than high-frequency electrosurgical generator group(P<0.05).There were no permanent RLN and permanent hypoparathyroidism in the two groups.There were no recurrence and metastasis during the follow-up period.Conclusions The microdissection tungsten needle is superior to the high-frequency electrosurgical generator in the protection of RLN and parathyroid gland in open thyroid surgery,which is worthy of promotion in clinical application.