双极电凝镊结合电刀在开放甲状腺手术中的应用价值
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摘要
目的:比较双极电凝镊结合电刀与单用电刀在甲状腺开放手术中的应用价值。方法:对我院2013年3月至2017年3月收治的300例甲状腺手术病人随机分为两组:采用双极电凝镊结合电刀为双极组,单用电刀为电刀组。两组在性别、年龄、疾病构成及肿瘤直径方面差异无统计学意义。所有手术均由同一组手术医师完成,比较两组的手术时间、术中失血量、术后引流量、术后手足麻木及抽搐、术后声音嘶哑等。结果:双极组在手术时间、术中失血量、术后手足麻木及抽搐、术后声音嘶哑方面与电刀组存在显著差异(均P<0.05),双极组优于电刀组。在术后引流量方面两组无显著差异。两组无永久性喉返神经损伤及甲状旁腺功能低下发生。结论:双极电凝镊结合电刀在开放甲状腺手术中的作用优于单用电刀,在开放甲状腺手术中应推广双极电凝镊的使用。
Objective: To compare the value of bipolar coagulation forceps combined with electrotome and alone electrotome in open thyroid surgery. Methods: 300 patients with thyroid surgery in our hospital from March 2013 to March 2017 were randomly divided into two groups: bipolar coagulation forceps( bipolar group) and the electrotome group. There were no significant differences in gender,age,disease composition and tumor diameter between the two groups. All operations were performed by the same group of surgeons. The operation time,intraoperative blood loss,postoperative drainage volume,postoperative numbness and convulsions of the hands and feet,postoperative hoarseness were compared between the two groups. Results: There were significant differences in the operation time,intraoperative blood loss,postoperative numbness and convulsions of the hands and feet,postoperative hoarseness between the bipolar group and the electrotome group( P < 0. 05). There was no difference in postoperative drainage volume between the two groups. There were no permanent laryngeal nerve palsy and permanent hypoparathyroidism in two groups. Conclusion: Bipolar coagulation forceps combined with electrotome is better than single electrotome in open thyroid surgery. We should promote the use of bipolar coagulation forceps in open thyroid surgery.
Objective: To compare the value of bipolar coagulation forceps combined with electrotome and alone electrotome in open thyroid surgery. Methods: 300 patients with thyroid surgery in our hospital from March 2013 to March 2017 were randomly divided into two groups: bipolar coagulation forceps( bipolar group) and the electrotome group. There were no significant differences in gender,age,disease composition and tumor diameter between the two groups. All operations were performed by the same group of surgeons. The operation time,intraoperative blood loss,postoperative drainage volume,postoperative numbness and convulsions of the hands and feet,postoperative hoarseness were compared between the two groups. Results: There were significant differences in the operation time,intraoperative blood loss,postoperative numbness and convulsions of the hands and feet,postoperative hoarseness between the bipolar group and the electrotome group( P < 0. 05). There was no difference in postoperative drainage volume between the two groups. There were no permanent laryngeal nerve palsy and permanent hypoparathyroidism in two groups. Conclusion: Bipolar coagulation forceps combined with electrotome is better than single electrotome in open thyroid surgery. We should promote the use of bipolar coagulation forceps in open thyroid surgery.
引文
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[6]中华医学会内分泌学会,中华医学会普通外科学分会,中国抗癌协会头颈肿瘤专业委员会,中华医学会核医学分会.甲状腺结节和分化型甲状腺癌诊治指南[C].广州:中华医学会第十一次全国内分泌学学术会议,2012.
[7]LAHEY T H.Routine dissection and demonstration of the recurrent laryngeal nerve in subtotal thyroidectomy[J].Surg Gynecol Obstet,1938,66:775-777.
[8]THOMPSON L D.Parathyroid carcinoma[J].Ear Nose Throat J,2009,88(1):722-724.
[9]DONNELLAN K A,PITMAN K A,CANNON C R,et al.Intraoperative laryngeal nerve monitoring during thyroidectomy[J].Arch Otolaryngol Head Neck Surg,2009,135:1196-1198.
[10]吕新生.甲状腺手术时喉返神经损伤的预防和治疗[J].中国普通外科杂志,2007,16(1):1-3.
[11]MAMSCH F,HUSSOCK J,HATING G,et al.Influence of muscle relaxation on neuromonitoring of the recurrent laryngeal nerve during thyroid surgery[J].Br J Anaesth,2005,94:596-600.
[12]ERBIL Y,BARBAROS U,SALMASLIOLGLU A,et a1.The advantage of near-total thyroidectomy to avoid postoperative hypoparathyroidism in benign multinodular goiter[J].Langenbecks Arch Surg,2006,391(6):567-573.
[13]UNALP H R,ERBIL Y,AKGUNER T,et a1.Does near total thyroidectomy offer advantage over total thyroidectomy in terms of postoperative hypocalcemia?[J].Int J Surg,2009,7(2):120-125.
[14]AGGELI C,ZOGRAFOS G N,NIXON A,et al.Postoperative hypoparathyroidism after thyroid surgery[J].Hellenic Journal of Surgery,2015,87(1):106-110.
[15]DUJOVNY M,DUJOVNY N,GUNDAMRAJ N R,et a1.Bipolar coagulation in neurosurgery[J].Surg Neurol,1998,49(3):328-332.
[16]PNIAK T,FORMANEK M,MATOUSEK P,et al.Bipolar thermofusion Bi Clamp 150 in thyroidectomy:a review of 1156 operation[J].Biomed Res Int,2014(2014):707265.
[17]BULSARA K R,SUKHLA S,NIMJEE S M.History of bipolar coagulation[J].Neurosurg Rev,2006,29(2):93-96.
[18]KHANNA S,KHURANA S,VIJ S.No clip,no ligature laparoscopic appendectomy[J].Surg Laparosc Endosc Percutan Tech,2004,14(4):201-203.
[19]魏涛,张明,李洁清,等.超声刀结合双极电凝镊与超声刀结合传统结扎方法在开放甲状腺手术中的应用——随机对照研究[J].中国普外基础与临床杂志,2012,19(2):157-164.
[2]MALIS L I.Electrosurgery.Technical note[J].J Neurosurg,1996,85(5):970-975.
[3]KIRIAKOPOULOS A,DIMITRIOS T,DIMITRIOS L.Use of a diathermy system in thyroid surgery[J].Arch Surg,2004,139(9):997-1000.
[4]SAINT MARC O,COGLIANDOLO A,PIQUARD A,et a1.Ligasure vs clamp-and-tie technique to achieve hemostasis in total thyroidectomy for benign multinodular goiter:a prospective randomized study[J].Arch Surg,2007,142(2):150-157.
[5]TYSOME J R,HASSAN R,DAVIS J.Standard bipolar diathermy forceps vessel ligation is safe in thyroidectomy[J].Eur Arch Otorhinolaryngol,2009,266(11):1781-1786.
[6]中华医学会内分泌学会,中华医学会普通外科学分会,中国抗癌协会头颈肿瘤专业委员会,中华医学会核医学分会.甲状腺结节和分化型甲状腺癌诊治指南[C].广州:中华医学会第十一次全国内分泌学学术会议,2012.
[7]LAHEY T H.Routine dissection and demonstration of the recurrent laryngeal nerve in subtotal thyroidectomy[J].Surg Gynecol Obstet,1938,66:775-777.
[8]THOMPSON L D.Parathyroid carcinoma[J].Ear Nose Throat J,2009,88(1):722-724.
[9]DONNELLAN K A,PITMAN K A,CANNON C R,et al.Intraoperative laryngeal nerve monitoring during thyroidectomy[J].Arch Otolaryngol Head Neck Surg,2009,135:1196-1198.
[10]吕新生.甲状腺手术时喉返神经损伤的预防和治疗[J].中国普通外科杂志,2007,16(1):1-3.
[11]MAMSCH F,HUSSOCK J,HATING G,et al.Influence of muscle relaxation on neuromonitoring of the recurrent laryngeal nerve during thyroid surgery[J].Br J Anaesth,2005,94:596-600.
[12]ERBIL Y,BARBAROS U,SALMASLIOLGLU A,et a1.The advantage of near-total thyroidectomy to avoid postoperative hypoparathyroidism in benign multinodular goiter[J].Langenbecks Arch Surg,2006,391(6):567-573.
[13]UNALP H R,ERBIL Y,AKGUNER T,et a1.Does near total thyroidectomy offer advantage over total thyroidectomy in terms of postoperative hypocalcemia?[J].Int J Surg,2009,7(2):120-125.
[14]AGGELI C,ZOGRAFOS G N,NIXON A,et al.Postoperative hypoparathyroidism after thyroid surgery[J].Hellenic Journal of Surgery,2015,87(1):106-110.
[15]DUJOVNY M,DUJOVNY N,GUNDAMRAJ N R,et a1.Bipolar coagulation in neurosurgery[J].Surg Neurol,1998,49(3):328-332.
[16]PNIAK T,FORMANEK M,MATOUSEK P,et al.Bipolar thermofusion Bi Clamp 150 in thyroidectomy:a review of 1156 operation[J].Biomed Res Int,2014(2014):707265.
[17]BULSARA K R,SUKHLA S,NIMJEE S M.History of bipolar coagulation[J].Neurosurg Rev,2006,29(2):93-96.
[18]KHANNA S,KHURANA S,VIJ S.No clip,no ligature laparoscopic appendectomy[J].Surg Laparosc Endosc Percutan Tech,2004,14(4):201-203.
[19]魏涛,张明,李洁清,等.超声刀结合双极电凝镊与超声刀结合传统结扎方法在开放甲状腺手术中的应用——随机对照研究[J].中国普外基础与临床杂志,2012,19(2):157-164.