Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Kliniken Essen-Mitte, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Henricistrasse 92, 45136 Essen, Germany.
Langenbecks Arch Surg. 2010 Feb;395(2):115-9. doi: 10.1007/s00423-009-0571-z.
One of the keystones in surgery of the thyroid gland is accurate hemostasis. This can be achieved by conventional ligations or new instruments as harmonic scissors or bipolar devices. In the present study, we report our experience with a new bipolar thermofusion vessel sealing system (TVS) compared to conventional vessel ligation (CVL).
This prospective non-randomized study included 186 patients operated on by two surgeons between April and November 2007. Age, gender, preoperative diagnosis, type of surgery, operative time, and complications were prospectively collected. TVS was used in 93 patients (29 M, 64 F; mean age 50+/-14 years, range 11-83) and CVL in 93 patients (27 M, 66 F; mean age 49+/-14 years, range 16-82). Results and postoperative complications were registered.
Postoperative complications included two cases of transient hypocalcaemia in both groups 1 (TVS group) and 2 (CVL group) hemorrhages requiring reoperation (p = ns). No recurrent laryngeal nerve palsy was observed in both groups. A drain was used in 25 cases in the TVS group and in 47 patients in the CVL group (p<0.008). Mean operative time for total thyroidectomy was significantly shorter in the TVS group (73+/-18 min, range=35-110) than in the CVL group (18+/-20 min, range = 40 -130; p<0.01). No differences were found for lobectomies or subtotal thyroidectomies.
TVS is safe with a similar complication rate as CVL. Mean operative time for total thyroidectomy is shortened with TVS.
甲状腺手术的关键之一是准确止血。这可以通过传统结扎或新仪器如超声刀或双极器械来实现。在本研究中，我们报告了一种新的双极热凝血管密封系统（TVS）与传统血管结扎（CVL）相比的经验。
这是一项前瞻性非随机研究，纳入了 2007 年 4 月至 11 月间由两位外科医生进行手术的 186 名患者。前瞻性收集年龄、性别、术前诊断、手术类型、手术时间和并发症。TVS 组 93 例（男 29 例，女 64 例；平均年龄 50+/-14 岁，范围 11-83 岁），CVL 组 93 例（男 27 例，女 66 例；平均年龄 49+/-14 岁，范围 16-82 岁）。记录结果和术后并发症。
术后并发症包括两组各有 1 例（TVS 组和 CVL 组）短暂性低钙血症和 2 例（TVS 组和 CVL 组）需要再次手术的出血（p=ns）。两组均未发生喉返神经麻痹。TVS 组 25 例和 CVL 组 47 例使用引流（p<0.008）。TVS 组全甲状腺切除术的平均手术时间明显短于 CVL 组（73+/-18 分钟，范围 35-110）（p<0.01）。行甲状腺叶切除术或次全甲状腺切除术时，两组之间无差异。
TVS 是安全的，与 CVL 的并发症发生率相似。TVS 可缩短全甲状腺切除术的平均手术时间。
