腔镜甲状腺手术人工气腔及隧道出血的临床分析
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摘要
目的探讨腔镜甲状腺手术人工气腔、隧道出血原因及防治方法。方法回顾2013年1月至2017年6月本科23例腔镜甲状腺手术气腔及隧道出血的病例资料,比较气腔及各个隧道出血的发生率,分析出血的原因、预防及处理。结果气腔出血2例(8.7%),隧道的出血共21例(91.3%),其中腔镜隧道出血1例(4.3%)、主操作隧道出血16例(69.6%)、副操作隧道4例(17.4%)。隧道出血发生率明显高于气腔,比较差异有统计学意义(P<0.05);主操作隧道出血发生率明显高于腔镜、副操作隧道,比较差异有统计学意义(P<0.05);腔镜隧道和副操作隧道出血发生率比较差异无统计学意义。偏离层面导致出血是最大的原因。结论腔镜甲状腺手术气腔、隧道出血的原因具有多样性,可有效预防,术中可彻底止血。
Objective Study on the causes, prevention and treatment of artificial gas cavity and tunnel bleeding in endoscopic thyroid surgery.Methods From January 2013 to June 2017, 23 cases of artificial gas cavity and tunnel bleeding in our department were reviewed, The incidence of bleeding in artificial gas cavity and every tunnel was compared, the causes of bleeding were analyzed, and the prevention and treatment were also made. Results There were 2 cases of artificial gas cavity bleeding(8.7%), 21 cases of tunnel bleeding(91.3%), including 1 cases of observation tunnel(4.3%), 16 cases of main operating tunnel(69.6%), 4 cases of auxiliary operation tunnel(17.4%). The incidence of bleeding in the tunnel was significantly higher than that in the gas cavity,the difference is statistically significant(P<0.05), the bleeding rate in the main operating tunnel was significantly higher than that in the observation tunnel, the difference is statistically significant(P<0.05), and there was no significant difference in the incidence of bleeding between the observation tunnel and the auxiliary tunnel. The biggest cause of bleeding is deviation from the plane.Conclusion The causes of artificial gas cavity and tunnel bleeding in endoscopic thyroid surgery are various, which can be prevented effectively and hemostatic completely during operation.
Objective Study on the causes, prevention and treatment of artificial gas cavity and tunnel bleeding in endoscopic thyroid surgery.Methods From January 2013 to June 2017, 23 cases of artificial gas cavity and tunnel bleeding in our department were reviewed, The incidence of bleeding in artificial gas cavity and every tunnel was compared, the causes of bleeding were analyzed, and the prevention and treatment were also made. Results There were 2 cases of artificial gas cavity bleeding(8.7%), 21 cases of tunnel bleeding(91.3%), including 1 cases of observation tunnel(4.3%), 16 cases of main operating tunnel(69.6%), 4 cases of auxiliary operation tunnel(17.4%). The incidence of bleeding in the tunnel was significantly higher than that in the gas cavity,the difference is statistically significant(P<0.05), the bleeding rate in the main operating tunnel was significantly higher than that in the observation tunnel, the difference is statistically significant(P<0.05), and there was no significant difference in the incidence of bleeding between the observation tunnel and the auxiliary tunnel. The biggest cause of bleeding is deviation from the plane.Conclusion The causes of artificial gas cavity and tunnel bleeding in endoscopic thyroid surgery are various, which can be prevented effectively and hemostatic completely during operation.
引文
[1]李进义,王存川,胡友主,等.完全腔镜甲状腺手术大出血的处理及防治[J].中国微创外科杂志,2015,l5(7):645-648.
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[8]何仕青,伍宏章,袁超杰,等.腔镜甲状腺手术术中出血的预防与处理[J].实用医学杂志,2013,29(14):2418-2419.
[9]梁俊杰,胡友主,赵琼,等.完全乳晕入路腔镜甲状腺切除术隧道出血的分析与处理[J].中国微创外科杂志,2015,15(2):136-139.
[2]胡超华,丁佑铭.精确被膜解剖法在腔镜甲状腺全切术中的应用[J].中国现代普通外科进展,2016,19(7):561-563.
[3]袁雁,章波,冯联忠.全腔镜甲状腺手术意外出血原因分析及对策[J].现代实用医学,2015,27(4):463-464.
[4]黄建平,刘岗,孔宪诚,等.减少皮下分离的直线型隧道在经胸壁入路腔镜甲状腺切除术中的应用[J].中国微创外科杂志,2O13,13(8):751-754.
[5]卢晓裕,谢容明,侯贤琼,等.超声刀在甲状腺手术中的应用[J].岭南现代临床外科,2015,15(5):604-606.
[6]周鑫,张思宇,苏国强.经胸壁人路腔镜下甲状腺全切除术20例报告[J].中国微创外科杂志,2014,14(8):735-737.
[7]张卫星,邓卫萍,李明,等.腋入路腔镜甲状腺手术中电凝钩的应用体会[J].中国现代医生,2016,54(13):51-54.
[8]何仕青,伍宏章,袁超杰,等.腔镜甲状腺手术术中出血的预防与处理[J].实用医学杂志,2013,29(14):2418-2419.
[9]梁俊杰,胡友主,赵琼,等.完全乳晕入路腔镜甲状腺切除术隧道出血的分析与处理[J].中国微创外科杂志,2015,15(2):136-139.