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采用 Thunderbeat™、LigaSure™ 或无能量器械治疗对头颈部癌症进行颈清扫术的短期疗效比较:一项病例对照研究。

A comparison of short-term outcomes of neck dissection for head and neck cancers using Thunderbeat™, LigaSure™ or treatment without an energy-based device: A case controlled study.

机构信息

Department of Otolaryngology, Head and Neck Surgery, Kansai Medical University Hospital, Japan.

Department of Otolaryngology, Head and Neck Surgery, Kansai Medical University Hospital, Japan.

出版信息

Int J Surg. 2018 Oct;58:60-64. doi: 10.1016/j.ijsu.2018.09.009. Epub 2018 Sep 21.

Abstract

OBJECTIVE

The aim of this study was to evaluate the efficacy of the new energy-based device Thunderbeat in neck dissection (ND) for head and neck cancer.

MATERIALS AND METHODS

We retrospectively examined 95 consecutive patients who underwent ND for head and neck squamous cell carcinoma between April 2013 and March 2018. The patients were divided into three groups: ND without the energy-based device (control group), ND using the LigaSure Small Jaw (LS group), and ND using the Thunderbeat Open Fine Jaw (TB group). The outcomes were compared among the three groups, as measured by the duration of ND (dissection time), blood loss during ND, and postoperative complications. We also analyzed the factors that may influence dissection time using multivariate analysis.

RESULTS

Compared to the control group, dissection time was found to be significantly shorter in both energy-based device groups (LS group and TB group) (96.4, 71.1, and 66.0 min, respectively, p = 0.0015) by univariate analysis. Blood loss during ND did not differ significantly among the three groups. Multivariate analysis showed that ND using the Thunderbeat as well as elderly patients (70 years and over), less extensive surgery (3 or fewer neck levels), and absence of extracapsular invasion were independently and significantly associated with shorter dissection time (p = 0.0069, 0.0337, <0.0001, and 0.0015, respectively). The incidence of postoperative complications in the LS group (20%) tended to be higher than those in the other groups (5.6% in the control group and 3.4% in the TB group), although the differences were not significant.

CONCLUSION

ND for head and neck cancers using the Thunderbeat is a safe and reliable method in terms of duration of dissection without increasing postoperative complications.

摘要

目的

本研究旨在评估新型能源设备 Thunderbeat 在头颈部癌症颈清扫术(ND)中的疗效。

材料与方法

我们回顾性分析了 2013 年 4 月至 2018 年 3 月期间 95 例连续行 ND 治疗的头颈部鳞癌患者。患者分为三组:未使用能量设备的 ND(对照组)、使用 LigaSure 小颌(LS)的 ND 和使用 Thunderbeat 开放式细颌(TB)的 ND。通过 ND 持续时间(解剖时间)、ND 期间出血量和术后并发症比较三组间的结果。我们还使用多变量分析分析了可能影响解剖时间的因素。

结果

与对照组相比,能量设备组(LS 组和 TB 组)的解剖时间明显缩短(分别为 96.4、71.1 和 66.0 分钟,p=0.0015)。ND 期间出血量在三组间无显著差异。多变量分析显示,Thunderbeat 联合使用、老年(70 岁及以上)、手术范围较小(3 个或更少颈部水平)和无包膜外侵犯与解剖时间缩短独立相关(p=0.0069、0.0337、<0.0001 和 0.0015)。LS 组(20%)术后并发症发生率高于其他两组(对照组 5.6%,TB 组 3.4%),但差异无统计学意义。

结论

Thunderbeat 在头颈部癌症 ND 中的应用是一种安全可靠的方法,在不增加术后并发症的情况下,解剖时间较短。

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