斜侧入路体位摆放预防甲状腺手术体位综合征的效果

The effectiveness of new posture method of hemithyroidectomy on reducing the posture symptom of thyroid surgery:a clinical observation

目的:评估斜侧入路手术体位摆放预防甲状腺手术体位综合征的效果。方法:回顾性分析2019年6月至2019年12月温州医科大学附属第一医院甲乳外科行甲状腺手术的患者,分为传统手术组(132例)和斜侧入路手术组(81例),观察两组患者手术体位综合征的发生情况,同时观察两组患者术中情况,包括切口长度、失血量、手术时间、术野暴露质量等指标。结果:传统手术组与斜侧入路手术组患者性别(33/99 vs.20/61,P=1.000)、年龄[(52.4±9.4)岁vs.(51.5±10.2)岁,P=0.546]、失血量[(16.80±2.64)mL vs.(16.72±2.61)mL,P=0.815]和手术时间[(64.25±5.45)min vs.(63.00±6.58)min,P=0.135]差异均无统计学意义;与传统手术组相比,斜侧入路手术组患者在不延长手术时间的前提下,其切口更短[(6.47±0.78)cm vs.(4.93±0.32)cm,P<0.001],手术体位综合征发生更少(耐受差发生率42.4%vs.16.0%,P<0.001;头痛61.4%vs.24.7%,P<0.001;恶心呕吐49.2%vs.17.3%,P<0.001),术野暴露质量更佳(1级暴露率49.2%vs.72.8%,P=0.001)。结论:斜侧入路手术体位摆放使手术体位从头部极度后仰改善到头部稍后仰,能有效减少甲状腺手术体位综合征的发生,是一种安全可行的方法。

Objective:To evaluate the effectiveness of the new posture method of hemithyroidectomy on reducing the posture symptom of thyroid surgery.Methods:Clinical data of 81 patients who underwent hemithyroidectomy and 132 patients who had traditional thyroidectomy from June 2019 to December 2019 in our hospital were analyzed retrospectively.Results:The gender(33/99 vs.20/61,P=1.000),age[(52.4±9.4)y vs.(51.5±10.2)y,P=0.546],bleeding[(16.80±2.64)mL vs.(16.72±2.61)mL,P=0.815]and operation time[(64.25±5.45)min vs.(63.00±6.58)min,P=0.135]of the two groups of patients had no statistical difference.Compared with the traditional surgery group,the patients who undergone hemithyroidectomy had shorter incision[(6.47±0.78)cm vs.(4.93±0.32)cm,P<0.001],less posture symptom of thyroid surgery(surgical tolerance 42.4%vs.16.0%,P<0.001;headache 61.4%vs.24.7%,P<0.001;nausea and vomiting 49.2%vs.17.3%,P<0.001)and better surgical field exposure(Level 1 exposure rate 49.2%vs.72.8%,P=0.001).Conclusion:The new posture method of hemithyroidectom,which is safe and feasible,can effectively reduce the occurrence of the posture symptom of thyroid surgery.