Polacco Marc A, Pintea Andrew M, Gosselin Benoit J, Paydarfar Joseph A
Department of Otolaryngology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03766, USA.
Head Face Med. 2017 May 11;13(1):8. doi: 10.1186/s13005-017-0141-5.
Parotidectomy is one of the most commonly performed procedures by otorhinolaryngologists. Traditionally dissection is performed with a combination of a steel scalpel and bipolar cautery; however, starting in the early 2000s, the Harmonic scalpel has provided an alternative method for dissection and hemostasis. The purpose of this study is to compare operative time, blood loss, complications, and cost between the Harmonic scalpel and steel scalpel plus bipolar cautery for superficial and total parotidectomy.
Retrospective cohort of patients who underwent superficial or total parotidectomy with the Harmonic or cold steel between 2000 and 2015. Across 255 patients, comparison between operative time, blood loss, complications, and cost was performed.
Superficial parotidectomy was performed on 120 patients with the Harmonic and 54 with steel scalpel. Total parotidectomy was performed on 59 patients using the Harmonic and 22 patients with cold steel. For superficial parotidectomy, the Harmonic reduced operative time (216 ± 42 vs. 234 ± 54 min, p = 0.03) and decreased blood loss (28 ± 19 vs. 76 ± 52 mls, p < 0.05). With total parotidectomy the Harmonic decreased operative time (240 ± 42 vs. 288 ± 78 min, p = 0.01) and reduced blood loss (38 ± 21 mls vs. 85 ± 55 mls, p < 0.05). There were no differences in complication rates between groups. Harmonic use was associated with surgical cost reduction secondary to reduced operative times.
The Harmonic scalpel decreases blood loss and operating time for superficial and total parotidectomy. Shorter operative times may decrease the overall cost of parotidectomy.
腮腺切除术是耳鼻喉科医生最常开展的手术之一。传统的手术解剖是使用手术刀和双极电凝器配合进行；然而，从21世纪初开始，超声刀为解剖和止血提供了另一种方法。本研究的目的是比较超声刀与手术刀加双极电凝器在浅表性和全腮腺切除术中的手术时间、失血量、并发症及成本。
对2000年至2015年间使用超声刀或冷刀进行浅表性或全腮腺切除术的患者进行回顾性队列研究。对255例患者的手术时间、失血量、并发症及成本进行比较。
120例患者使用超声刀进行浅表性腮腺切除术，54例使用手术刀。59例患者使用超声刀进行全腮腺切除术，22例使用冷刀。对于浅表性腮腺切除术，超声刀缩短了手术时间（216±42分钟对234±54分钟，p = 0.03）并减少了失血量（28±19毫升对76±52毫升，p < 0.05）。在全腮腺切除术中，超声刀缩短了手术时间（240±42分钟对288±78分钟，p = 0.01）并减少了失血量（38±21毫升对85±55毫升，p < 0.05）。两组间并发症发生率无差异。使用超声刀因手术时间缩短而降低了手术成本。
超声刀可减少浅表性和全腮腺切除术的失血量及手术时间。较短的手术时间可能会降低腮腺切除术的总体成本。
