直型双极电凝镊与超声刀在甲状腺全切加中央区淋巴结清扫术中的应用对比分析

Comparative analysis of the efficacies of straight bipolar coagulation forceps and harmonic scalpel in total thyroidectomy combined with central lymph node dissection

目的对比分析直型双极电凝系统与超声刀在甲状腺双侧全切加患侧中央区淋巴结清扫术中的应用效果。方法回顾性分析2018年6月至2020年6月就诊于徐州医科大学附属淮安医院行开放性甲状腺双侧全切加患侧中央区淋巴结清扫术的120例甲状腺乳头状癌患者的临床资料,根据是否使用直型双极电凝,分为双极电凝组(试验组)60例和超声刀组(对照组)60例,比较两组患者总手术时间、术中出血量、术后第1天引流量、术后出血、术后声嘶症状、低钙血症的症状。结果双极电凝组总手术时间(75.82±6.20)min,显著短于超声刀组(86.62±5.66)min(P<0.05);双极电凝组术中出血量(21.08±3.16)ml,显著少于超声刀组(30.16±4.22)ml(P<0.05);双极电凝组术后第一天引流量(30.12±3.46)ml,与超声刀组(30.56±3.28)ml相比(P>0.05),差异无统计学意义。两组手术患者术后均没有出血病例。双极电凝组出现暂时性声音嘶哑总发生率为3.33%低于超声刀组的8.33%(P<0.05),双极电凝镊组不同程度手足麻木等低钙血症总发生率为6.67%低于超声刀组的13.33%(P<0.05)。结论直型双极电凝镊是施行甲状腺全切加中央区淋巴结清扫术的理想工具,具有较好的应用前景。

Objective To compare the efficacies of straight bipolar coagulation forceps and harmonic scalpel in total thyroidectomy combined with central lymph node dissection.Methods The data of 120 patients of thyroid papillary carcinoma with open total thyroidectomy and central lymph node dissection from Jun.2018 to Jun.2020 in the Affiliated Huaian Hospital of Xuzhou Medical University were retrospectively analyzed.The patients were divided into bipolar electrocoagulation group(the experimental group)and harmonic scalpel group(the control group)according to the different surgical instruments.The total operation time,intraoperative hemorrhage,postoperative drainage volume on the first day,postoperative bleeding,postoperative hoarseness and hypocalcemia were compared between the two groups.Results The total operation time and intraoperative hemorrhage in the bipolar electrocoagulation group were significantly lower than those in the harmonic scalpel group(75.82±6.20)min vs(86.62±5.66)min,(21.08±3.16)ml vs(30.16±4.22)ml(both P<0.05).There was no significant difference between the two groups in postoperative drainage volume on the first day(P>0.05).No cases of postoperative bleeding was found.The incidence of postoperative hoarseness in the bipolar electrocoagulation group(3.33%)was lower than that in the harmonic scalpel group(8.33%),(P<0.05).The incidence of hypocalcemia in the bipolar electrocoagulation group(6.67%)was also lower than that in the harmonic scalpel group(13.33%),(P<0.05).Conclusions The straight bipolar coagulation forceps is an ideal tool in total thyroidectomy and central lymph node dissection.