甲状腺日间手术围术期管理
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摘要
我国甲状腺癌和甲状腺结节发病率呈上升趋势,外科手术是甲状腺结节和甲状腺癌的主要治疗手段。甲状腺手术是否适合日间手术模式一直饱受争论。完善的术前检查、术前麻醉评估、严格筛选患者,选择微创手术方式和合适的麻醉方式、良好的术后镇痛和防治术后恶心呕吐,及时发现和处理术后并发症,建立术后随访机制,可以保障甲状腺日间手术患者安全,取得与住院手术相同的医疗质量。严格控制适应证后,甲状腺日间手术具有安全高效、方便快捷的特点,能明显降低住院时间和住院费用,是一种合理手术管理方式。目前患者的入选和排除标准,麻醉技术和围术期路径管理仍需要进一步研究。
The incidence rate of thyroid cancer and thyroid nodule in China are rising and surgical operation is the main treatment for thyroid nodule and thyroid carcinoma. It has been controversial whether thyroid surgery is suitable for day surgery. Perfect preoperative examination and anesthesia assessment, selection of an appropriate of patients and minimally invasive surgery, good postoperative analgesia and the prevention and treatment of postoperative nausea and vomiting, recognition and treatment of postoperative complications timely, postoperative follow-up, can ensure safety of patient with thyroid ambulatory surgery,and made the same medical quality as the surgery in hospital. Under certain criteria, thyroid ambulatory surgery is safety,high efficient, economy and time-efficient. It is a reasonable surgical management mode which can reduce days of hospitalization and hospitalization cost. But it still need further study on the inclusion and exclusion criteria of patients, anesthesia techniques and perioperative management.
The incidence rate of thyroid cancer and thyroid nodule in China are rising and surgical operation is the main treatment for thyroid nodule and thyroid carcinoma. It has been controversial whether thyroid surgery is suitable for day surgery. Perfect preoperative examination and anesthesia assessment, selection of an appropriate of patients and minimally invasive surgery, good postoperative analgesia and the prevention and treatment of postoperative nausea and vomiting, recognition and treatment of postoperative complications timely, postoperative follow-up, can ensure safety of patient with thyroid ambulatory surgery,and made the same medical quality as the surgery in hospital. Under certain criteria, thyroid ambulatory surgery is safety,high efficient, economy and time-efficient. It is a reasonable surgical management mode which can reduce days of hospitalization and hospitalization cost. But it still need further study on the inclusion and exclusion criteria of patients, anesthesia techniques and perioperative management.
引文
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[18]Houlton JJ,Pechter W,Steward DL.PACU PTH facilitates safe outpatient total thyroidectomy[J].Otolaryngol Head Neck Surg,2011,144(1):43-47.DOI:10.1177/0194599810390453.
[19]Payne RJ,Hier MP,Tamilia M,et al.Same-day discharge after total thyroidectomy:the value of 6-hour serum parathyroid hormone and calcium levels[J].Head Neck,2005,27(1):1-7.DOI:10.1002/hed.20103.
[20]Zhou H,Xu H,Zhang J,et al.Combination of dexamethasone and tropisetron before thyroidectomy to alleviate postoperative nausea,vomiting,and pain:randomized controlled trial[J].World J Surg,2012,36(6):1217-1224.DOI:10.1007/s00268-011-1363-5.
[21]Han SS,Do SH,Kim TH,et al.Stepwise tapering of remifentanil at the end of surgery decreased postoperative pain and the need of rescue analgesics after thyroidectomy[J].BMC Anesthesiol,2015,15:46.DOI:10.1186/s12871-015-0026-8.
[2]孔丹丹,张彩芬.健康体检人群中甲状腺结节流行病学调查[J].中国临床保健杂志,2015,18(1):70-71.DOI:10.3969/J.issn.1672-6790.2015.01.024.
[3]任宏义,吴光耀,郑齐超,等.12240例健康体检人群甲状腺结节流行病学调查[J].世界最新医学信息文摘:连续型电子期刊,2015,15(58):13-14,16.D01:10.3969/j.issn.1671-3141.2015.58.008.
[4]刘乔勇,苏虹.某三级医院在职医护人员甲状腺结节流行病学调查[J].中华全科医学,2017,15(4):641-643.DOI:10.16766/j.cnki.issn.1674-4152.2017.04.030.
[5]Gilmartin J,Wright K.Day surgery:patients'felt abandoned during the preoperative wait[J].J Clin Nurs,2008,17(18):2418-2425.DOI:10.1111/j.1365-2702.2008.02374.x.
[6]杨霞,卢惠娟,赵爱平,等.早期心理与信息支持对甲状腺日间手术患者术前应激的影响[J].护理学杂志,2011,26(2):54-56.DOI:10.3870/hlxzz.2011.02.054.
[7]Materazzi G,Dionigi G,Berti P,et al.One-day thyroid surgery:retrospective analysis of safety and patient satisfaction on a consec-utive series of 1,571 cases over a three-year period[J].Eur Surg Res,2007,39(3):182-188.DOI:10.1159/000100904.
[8]毛林锋,袁正泰,刘序,等.甲状腺日间手术的临床初探[J].中南大学学报:医学版,2016,41(3):305-312.DOI:10.11817/j.issn.1672-7347.2016.03.013.
[9]Torfs A,Laureyns G,Lemkens P.Outpatient hemithyroidectomy:safety and feasibility[J].B-ENT,2012,8(4):279-283.
[10]戴佳奇,吴婷婷,殷志强,等.甲状腺日间手术规范化分析[J].肿瘤学杂志,2015,21(6):454-458.DOI:10.11735/j.issn.1671-170X.2015.06.B002.
[11]郭曲练,程智刚.研究和规范日间手术麻醉及围术期管理意义重大[J].临床麻醉学杂志,2016,32(10):941-944.2016,32(10):941-944.
[12]Karthikeyan VS,Sistla SC,Badhe AS,et al.Randomized controlled trial on the efficacy of bilateral superficial cervical plexus block in thyroidectomy[J].Pain Pract,2013,13(7):539-546.DOI:10.1111/papr.12022.
[13]Spanknebel K,Chabot JA,DiGiorgi M,et al.Thyroidectomy using monitored local or conventional general anesthesia:an analysis of outpatient surgery,outcome and cost in 1,194 consecutive cases[J].World J Surg,2006,30(5):813-824.DOI:10.1007/s00268-005-0384-3.
[14]Snyder SK,Roberson CR,Cummings CC,et al.Local Anesthesia With Monitored Anesthesia Care vs General Anesthesia in Thyroidectomy:A Randomized Study[J].Arch Surg,2006,141(2):167-173.DOI:10.1001/archsurg.141.2.167.
[15]Bergamaschi R,Becouarn G,Ronceray J,et al.Morbidity of thyroid surgery[J].Am J Surg,1998,176(1):71-75.
[16]Burkey SH,van Heerden JA,Thompson GB,et al.Reexploration for symptomatic hematomas after cervical exploration[J].Surgery,2001,130(6):914-920.DOI:10.1067/msy.2001.118384.
[17]Leyre P,Desurmont T,Lacoste L,et al.Does the risk of compressive hematoma after thyroidectomy authorize 1-day surgery?[J].Langenbecks Arch Surg,2008,393(5):733-737.DOI:10.1007/s00423-008-0362-y.
[18]Houlton JJ,Pechter W,Steward DL.PACU PTH facilitates safe outpatient total thyroidectomy[J].Otolaryngol Head Neck Surg,2011,144(1):43-47.DOI:10.1177/0194599810390453.
[19]Payne RJ,Hier MP,Tamilia M,et al.Same-day discharge after total thyroidectomy:the value of 6-hour serum parathyroid hormone and calcium levels[J].Head Neck,2005,27(1):1-7.DOI:10.1002/hed.20103.
[20]Zhou H,Xu H,Zhang J,et al.Combination of dexamethasone and tropisetron before thyroidectomy to alleviate postoperative nausea,vomiting,and pain:randomized controlled trial[J].World J Surg,2012,36(6):1217-1224.DOI:10.1007/s00268-011-1363-5.
[21]Han SS,Do SH,Kim TH,et al.Stepwise tapering of remifentanil at the end of surgery decreased postoperative pain and the need of rescue analgesics after thyroidectomy[J].BMC Anesthesiol,2015,15:46.DOI:10.1186/s12871-015-0026-8.