Hahn Christoffer Holst, Trolle Waldemar, Sørensen Christian Hjort
ENT Department, Rigshospitalet/Gentofte University Hospital, Copenhagen, Denmark.
ENT Department, Rigshospitalet/Gentofte University Hospital, Copenhagen, Denmark.
Auris Nasus Larynx. 2015 Aug;42(4):311-7. doi: 10.1016/j.anl.2014.12.007. Epub 2015 Mar 6.
No previous prospective study has evaluated harmonic scalpel in thyroidectomy for substernal goiter. The objective of this study was to evaluate the use of harmonic scalpel (FOCUS shear, Ethicon Endo-Surgery) in thyroidectomy for substernal goiter for blood loss, operative time, hospital stay and complications.
Prospective non-randomised study of 242 consecutive patients with substernal goiter out of 2258 patients (11%) who underwent thyroidectomy. A total of 121 patients had thyroidectomy performed with bipolar electrocoagulation and knot-tying techniques and 121 patients had harmonic scalpel thyroidectomy.
The use of harmonic scalpel was associated with significant reduction in intraoperative blood loss (50 vs. 100mL, p=0.001), postoperative haemorrhage (4% vs. 12%, p=0.03) and length of hospital stay (2 vs. 3 days, p=0.001). The mean operative time was significantly longer in the harmonic group.
Harmonic scalpel is a safe tool for thyroidectomy for substernal goiter. Its utilisation is associated with reduced blood loss, lower incidence of postoperative haemorrhage and shorter hospital stay.
既往尚无前瞻性研究评估谐波手术刀在胸骨后甲状腺肿甲状腺切除术中的应用。本研究的目的是评估谐波手术刀（FOCUS 剪切刀，爱惜康内镜外科公司）在胸骨后甲状腺肿甲状腺切除术中的失血情况、手术时间、住院时间及并发症。
对 2258 例行甲状腺切除术患者中的 242 例（11%）连续性胸骨后甲状腺肿患者进行前瞻性非随机研究。其中 121 例患者采用双极电凝和打结技术行甲状腺切除术，121 例患者采用谐波手术刀行甲状腺切除术。
使用谐波手术刀可显著减少术中失血（50 对 100mL，p = 0.001）、术后出血（4%对 12%，p = 0.03）及缩短住院时间（2 对 3 天，p = 0.001）。谐波组平均手术时间明显更长。
谐波手术刀是胸骨后甲状腺肿甲状腺切除术的一种安全工具。其应用与减少失血、降低术后出血发生率及缩短住院时间相关。
