Carlander Johan, Wagner Philippe, Gimm Oliver, Nordenström Erik, Jansson Svante, Bergkvist Leif, Johansson Kenth
World J Surg. 2016 Jan;40(1):117-23. doi: 10.1007/s00268-015-3270-7.
Energy-based surgical devices (EBD) combining cutting and coagulation are increasingly used in thyroid surgery. However, there is a lack of information about potential benefits and risk of complications outside controlled trials. The aims of this national multicenter register study were to describe the use of EDB, their potential effect on complication rates, and on operation time.
The Scandinavian Quality Register for Thyroid and Parathyroid surgery includes 35 surgical units in Sweden and covered 88% of the thyroid procedures performed during 2008–2009. The use of the EBD was specifically registered for 12 months, and 1297 patients were included. Surgically related complications and operation time were evaluated. The clamp-and-tie group (C-A-T) constituted the control group for comparison with procedures where EBD was used.
The thyroid procedures performed included C-A-T (16.6%), bipolar electrosurgery (ES: 56.5%), electronic vessel sealing (EVS: 12.2%), and ultrasonic dissection (UD: 14.5%). Mean operative time was longer with EVS (p < 0.001) and shorter with UD (p < 0.05) than in the other groups. The bipolar ES group and the EVS group had higher incidence of calcium treatment at discharge and after 6 weeks than the UD group. No significant difference in nerve injury was found between the groups. There was a significant more frequent use of topical hemostatic agents in the EBD group compared to C-A-T.
In this national multicenter study, the use of UD shortened and EVS increased operating time. There was a higher risk of calcium treatment at discharge and after 6 weeks after use of EVS and bipolar ES than after UD use. There was a significant more frequent use of topical hemostatic agents in the EBD groups compared to C-A-T.
兼具切割和凝血功能的能量型手术器械（EBD）在甲状腺手术中的应用日益广泛。然而，在对照试验之外，关于其潜在益处及并发症风险的信息匮乏。这项全国多中心登记研究的目的是描述EBD的使用情况、其对并发症发生率及手术时间的潜在影响。
斯堪的纳维亚甲状腺和甲状旁腺手术质量登记处涵盖瑞典的35个手术科室，涵盖了2008 - 2009年期间88%的甲状腺手术。EBD的使用情况被专门记录了12个月，共纳入1297例患者。对手术相关并发症及手术时间进行了评估。钳扎组（C - A - T）作为对照组，用于与使用EBD的手术进行比较。
所进行的甲状腺手术包括钳扎术（C - A - T，16.6%）、双极电外科手术（ES：56.5%）、电子血管闭合术（EVS：12.2%）和超声解剖术（UD：14.5%）。与其他组相比，EVS组的平均手术时间更长（p < 0.001），UD组的平均手术时间更短（p < 0.05）。双极ES组和EVS组出院时及6周后的钙治疗发生率高于UD组。各小组之间在神经损伤方面未发现显著差异。与C - A - T组相比，EBD组局部止血剂的使用频率显著更高。
在这项全国多中心研究中，UD的使用缩短了手术时间，而EVS延长了手术时间。使用EVS和双极ES后出院时及6周后的钙治疗风险高于使用UD后。与C - A - T组相比，EBD组局部止血剂的使用频率显著更高。
