Blankenship D Russ, Gourin Christine G, Porubsky Edward A, Porubsky Edward S, Klippert Frederick N, Whitaker Elizabeth G, Terris David J
Department of Otolarygology-Head and Neck Surgery, Medical College of Georgia, Augusta 30912, USA.
Otolaryngol Head Neck Surg. 2004 Oct;131(4):397-400. doi: 10.1016/j.otohns.2004.03.043.
Use of the Harmonic Scalpel has recently been described in thyroid surgery, in which it appears to result in decreased operative time and blood loss without increasing the incidence of nerve injury when compared to conventional techniques of vessel ligation and tissue division. We sought to determine whether the use of the Harmonic Scalpel in superficial parotidectomy was associated with a difference in operative time, blood loss, or facial nerve injury compared with conventional techniques.
The medical records of all patients who underwent superficial parotidectomy for benign parotid pathology at the Medical College of Georgia and Veterans Affairs Hospital of Augusta, Georgia, from 1999 to 2002 were retrospectively reviewed. Patients were excluded if they had a history of a bleeding disorder, prior facial nerve weakness, prior parotid surgery, malignant pathology, or required total parotidectomy.
Forty-two patients were eligible for inclusion. Nineteen patients underwent Harmonic Scalpel parotidectomy (HS) and 21 patients underwent conventional parotidectomy (control group). There were no significant differences between the 2 groups with respect to demographic data, pathology, or tumor size. Use of the Harmonic Scalpel was associated with a significant reduction in length of surgery (167.5 +/- 42.6 min vs. 195.5 +/- 37.4 min for controls, P = 0.03) and intraoperative blood loss (37.5 +/- 25.8 mL vs. 60.0 +/- 37.1 mL for controls, P = 0.03). There were no significant differences between the HS or control groups with respect to postoperative drain output (48.7 +/- 33.8 mL vs. 48.0 +/- 22.9 mL, respectively, P > 0.05) or facial nerve function.
Use of the Harmonic Scalpel for superficial parotidectomy is safe and may result in reduced operative time and blood loss compared with conventional techniques. Significance A safe alternative to cold knife superficial parotidectomy is presented with the potential benefits of reduced operative time and blood loss demonstrated.
近期有研究报道了谐波手术刀在甲状腺手术中的应用，与传统的血管结扎和组织分离技术相比，谐波手术刀似乎能缩短手术时间、减少术中出血量，且不会增加神经损伤的发生率。我们旨在确定在腮腺浅叶切除术中，与传统技术相比，使用谐波手术刀在手术时间、出血量或面神经损伤方面是否存在差异。
回顾性分析了1999年至2002年在佐治亚医学院和佐治亚州奥古斯塔退伍军人事务医院接受腮腺浅叶切除术治疗腮腺良性病变的所有患者的病历。有出血性疾病史、既往面神经麻痹、既往腮腺手术史、恶性病变或需要行腮腺全切除术的患者被排除。
42例患者符合纳入标准。19例患者接受谐波手术刀腮腺切除术（HS组），21例患者接受传统腮腺切除术（对照组）。两组在人口统计学数据、病理类型或肿瘤大小方面无显著差异。使用谐波手术刀可显著缩短手术时间（HS组167.5±42.6分钟，对照组195.5±37.4分钟，P = 0.03）和减少术中出血量（HS组37.5±25.8毫升，对照组60.0±37.1毫升，P = 0.03）。HS组和对照组在术后引流量（分别为48.7±33.8毫升和48.0±22.9毫升，P>0.05）或面神经功能方面无显著差异。
与传统技术相比，谐波手术刀用于腮腺浅叶切除术是安全的，且可能缩短手术时间、减少术中出血量。意义：提出了一种安全的冷刀腮腺浅叶切除术替代方法，并证明了其具有缩短手术时间和减少出血量的潜在益处。
