一种新型结节定位装置在甲状腺手术的应用

背景与目的:甲状腺结节的发病率逐年升高,手术切除为甲状腺小结节的病理诊断和治疗提供了理想方法,但是对小结节的定位成为手术过程中的一大难题。本研究的目的在于明确一种新型甲状腺结节定位装置在甲状腺手术中的可行性和安全性。方法:在超声引导下,运用该定位装置在术前对有强烈手术意愿的患者进行甲状腺结节精准定位。随后对该项技术进行回顾性研究,以评估该新型定位技术的安全性和可行性。主要结局指标包括探究该项定位技术的安全性(定位过程是否导致出血以及其他不良反应)和成功率(能否精准定位甲状腺微小结节并且将其成功切除);次要结局指标包括可行性(定位过程持续时间以及定位装置是否失败和损坏)。结果:共对29例甲状腺切除手术患者的29个甲状腺微小结节进行术前精准定位。总体而言,28例患者的甲状腺微小结节被成功精准定位并切除,未出现术中定位钩子断裂或者脱落的情况。1例患者出现了结节与定位针钩子之间存在距离偏差,最终扩大切除范围后才将结节切除。其中结节直径大小中位数为0.5 cm,定位过程的时间平均数为13 min。没有病人在手术过程中或术后出现明显的相关并发症。结论:在甲状腺手术中使用该定位装置安全可靠,具有较高的定位成功率,能提高对甲状腺疾病的诊断率,同时也方便临床手术医生操作。是一种具有一定临床应用价值的结节精准定位技术。Background & Objective: The incidence of thyroid nodules is increasing year by year. Surgical resection provides an ideal method for the pathologic diagnosis and treatment of thyroid nodules, but the localization of nodules is a major problem in the surgical process. The objective of this study was to determine the feasibility and safety of a novel thyroid nodule localization device in thyroid surgery. Methods: Under the guidance of ultrasound, the localization device was used to accurately locate thyroid nodules in patients with a strong desire for surgery. Subsequently, a retrospective study was conducted to evaluate the safety and feasibility of this novel positioning technology. Primary outcome measures included examining the safety of the localization technique (whether the localization process resulted in bleeding and other adverse effects) and success rate (whether the tiny thyroid nodules could be accurately located and successfully removed). Secondary outcome measures include feasibility (duration of the positioning process and whether the positioning device fails and is damaged). Results: A total of 29 thyroid micronodules in 29 patients undergoing thyroidectomy were accurately located before the operation. Overall, the thyroid micronodules were successfully located and removed in 28 patients without intraoperative location hook breakage or loss. In 1 patient, there was a distance deviation between the nodules and the positioning needle hook, and the nodules were removed only after the scope of resection was expanded. The median diameter of nodules was 0.5cm. The average time of the positioning process was 13 minutes. None of the patients had significant complications during or after the procedure. Conclusion: The localization device is safe and reliable in thyroid surgery, and has a high localization success rate, which can improve the diagnosis rate of thyroid diseases and facilitate the operation of clinical surgeons. It is an accurate nodule localization technique with a certain clinical application value.

胰黏液性囊腺瘤误诊为胰腺假性囊肿反复手术治疗1例

1临床资料 患者,女,52岁。因2d前出现发热,伴恶心呕吐,上腹部胀痛于2013年3月4日收入南昌大学第一附属医院。1987年,因胰腺囊肿,在当地医院行胰腺囊肿内引流术。2007年,胰腺囊肿复发,遂于当地医院行胰腺囊肿空肠Roux-en-Y式吻合术。

日间经口腔前庭入路腔镜甲状腺癌根治术可行性及安全性研究

目的 分析在日间病房围手术期模式下经口腔前庭入路腔镜甲状腺癌根治术的可行性、安全性及优势。方法 回顾性分析2019年1月至2021年4月南昌大学第一附属医院行经口腔前庭入路腔镜单侧甲状腺癌根治术235例病人的临床资料。其中行日间围手术期模式下经口腔前庭入路腔镜单侧甲状腺癌根治术125例(日间组),常规围手术期模式下经口腔前庭入路腔镜单侧甲状腺癌根治术110例(常规组)。对比分析两组病人的手术参数、术后并发症及住院参数等临床数据。结果 日间组125例病人中出现5例暂时性喉返神经损伤、1例感染及1例术后酒窝征,未出现其他并发症。常规组110例病人中出现5例暂时性喉返神经损伤,1例感染,1例术后味觉异常,1例暂时性甲状旁腺功能减退,未出现其他并发症。两组术后并发症对比差异无统计学意义。日间组手术预约时间及住院时间均短于常规组(P<0.01),日间组住院费用更低(P<0.01),病人满意度更高(P<0.01)。结论 通过严格的多学科综合治疗协作组评估与围手术期管理,日间病房围手术期模式下行经口腔前庭入路腔镜甲状腺癌根治术能安全有效地开展,在取得良好的治疗效果和美容效果的同时,有效缩短病人的住院时间,降低住院费用,提升病人的住院满意度。