McNally Michael M, Agle Steven C, Williams R Fredrick, Pofahl Walter E
Department of Surgery, East Carolina University, Brody School of Medicine, Greenville, NC 27858, USA.
Am Surg. 2009 Nov;75(11):1073-6.
Safe thyroid surgery requires meticulous hemostasis. The objective of the current study is to compare the effectiveness and safety of ultrasonic dissection (UD) and electronic vessel sealing (EVS) in patients undergoing thyroidectomy. A retrospective analysis of a prospectively maintained database was performed. Between January 1, 2007 and January 25, 2008, hemostasis was achieved using EVS (LigaSure Precise, Valleylab, Boulder, CO). Since January 25, 2008, hemostasis has been achieved using UD (Harmonic Focus, Ethicon Endo-Surgery, Cincinnati, OH). Operative time, estimated blood loss, gland weight, and postoperative complications were compared. Differences were analyzed using unpaired t test and Chi square with significance assigned P < 0.05. Seventy-four patients underwent total thyroidectomy (EVS n = 59, UD n = 15). Operative time (EVS 115.0 +/- 38.3 min, UD 88.0 +/- 14.0 min, P = 0.012) was significantly decreased in the UD group compared with the EVS group. There were no significant differences in mean age (EVS 50.4 +/- 13.9 years, UD 49.1 +/- 15.6 years), gender distribution (EVS 78% female, UD 87% female), estimated blood loss (EVS 49.4 +/- 44.7 mL, UD 47.0 +/- 70.4 mL), and gland weight (EVS 67.4 +/- 66.4 gm, UD 41.3 +/- 26.6 gm). Analysis of complications, including hematoma, hypocalcemia, and recurrent laryngeal nerve palsy showed no significant difference. Based on the current analysis, ultrasonic dissection is a safe method of hemostasis for thyroid surgery. Its use decreases operative time when compared with electronic vessel sealing.
安全的甲状腺手术需要细致的止血。本研究的目的是比较超声刀（UD）和电子血管闭合系统（EVS）在甲状腺切除术中的有效性和安全性。对前瞻性维护的数据库进行了回顾性分析。2007年1月1日至2008年1月25日期间，使用EVS（LigaSure Precise，Valleylab，博尔德，科罗拉多州）进行止血。自2008年1月25日起，使用UD（Harmonic Focus，Ethicon Endo-Surgery，辛辛那提，俄亥俄州）进行止血。比较了手术时间、估计失血量、腺体重量和术后并发症。使用不成对t检验和卡方检验分析差异，显著性设定为P < 0.05。74例患者接受了全甲状腺切除术（EVS组n = 59，UD组n = 15）。与EVS组相比，UD组的手术时间（EVS 115.0 +/- 38.3分钟，UD 88.0 +/- 14.0分钟，P = 0.012）显著缩短。平均年龄（EVS 50.4 +/- 13.9岁，UD 49.1 +/- 15.6岁）、性别分布（EVS组女性占78%，UD组女性占87%）、估计失血量（EVS 49.4 +/- 44.7毫升，UD 47.0 +/- 70.4毫升）和腺体重量（EVS 67.4 +/- 66.4克，UD 41.3 +/- 26.6克）均无显著差异。对包括血肿、低钙血症和喉返神经麻痹在内的并发症分析显示无显著差异。基于目前的分析，超声刀是甲状腺手术中一种安全的止血方法。与电子血管闭合系统相比，其使用可缩短手术时间。
