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[精细解剖技术结合直型双极电凝镊在甲状腺手术中的应用]

[Application of meticulous anatomy skills with straight bipolar electric coagulation forceps in thyroid surgery].

作者信息

Zhang S W, An C M, Huang R C, Li X J, Zhao L F, Xu H Y, Hai Y, Wang H, Qiu Y Y

机构信息

First Department of Head and Neck Surgery, the Cancer Hospital of Yunnan Province, the Third Affiliated Hospital of Kunming Medical University, Kunming 650118, China.

Department of Head and Neck Surgery, Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100021, China.

出版信息

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Feb 7;55(2):139-143. doi: 10.3760/cma.j.issn.1673-0860.2020.02.010.

Abstract

To compare the efficacies of the two techniques of "micro-hemostasis and micro-cutting" with straight bipolar electrocoagulation forceps and traditional clamp-ligation for hemostasia in thyroid surgery. A total of 228 patients who underwent surgical treatment for thyroid neoplasms in our hospital between January 2015 and December 2018 were retrospectively analyzed, including 50 males and 178 females, aged 23-68 years old. Of those, 150 cases as electric knife group received traditional thyroid surgery between January 2015 and December 2018 and 78 cases as bipolar electrocoagulation group received thyroid surgery by using the technique of bipolar electrocoagulation with meticulous anatomy between January 2018 and December 2018. The total operation time, single operation time, intraoperative hemorrhage, postoperative drainage volume on the first day, postoperative hoarseness and hypocalcemia were compared between the two groups. SPSS 16.0 was used to analyze the data. The total operation time and intraoperative hemorrhage in the bipolar electrocoagulation group were significantly lower than those in the electric knife group ((59.33±18.29)min (77.21±25.39)min, (14.83±9.22)ml (36.86±11.80)ml, all 0.01). The single operation time of the bipolar electrocoagulation group was shorter than that of the electric knife group((10.25±6.16) min (20.34±7.24)min, (16.25±7.15)min (35.68±8.25)min, (12.12±5.25)min (20.68±7.26)min, value was 3.948,16.262,8.238, all 0.01).There was no significant difference between the two groups in postoperative drainage volume on the first day (0.05) and the incidence of postoperative hoarseness (0.05), while the incidence of hypocalcemia in the bipolar electrocoagulation group(10.26%) was lower than that in the electric knife group(21.33%,χ(2)=4.353, 0.05). The fine dissection for thyroid operation can be achieved by using straight bipolar electrocoagulation tweezers. The use of "micro-hemostasis" and "micro-cutting" technique with bipolar electrocoagulation tweezers can greatly reduce intraoperative bleeding, operation time and postoperative complication.

摘要

比较甲状腺手术中使用直型双极电凝镊的“微止血与微切割”技术和传统钳夹结扎技术的止血效果。回顾性分析2015年1月至2018年12月在我院接受甲状腺肿瘤手术治疗的228例患者,其中男性50例,女性178例,年龄23 - 68岁。其中,150例为电刀组,于2015年1月至2018年12月接受传统甲状腺手术;78例为双极电凝组,于2018年1月至2018年12月采用双极电凝技术并精细解剖进行甲状腺手术。比较两组的总手术时间、单次手术时间、术中出血量、术后第一天引流量、术后声音嘶哑及低钙血症情况。采用SPSS 16.0软件进行数据分析。双极电凝组的总手术时间和术中出血量显著低于电刀组((59.33±18.29)分钟对(77.21±25.39)分钟,(14.83±9.22)毫升对(36.86±11.80)毫升,均P<0.01)。双极电凝组的单次手术时间短于电刀组((10.25±6.16)分钟对(20.34±7.24)分钟,(16.25±7.15)分钟对(35.68±8.25)分钟,(12.12±5.25)分钟对(20.68±7.26)分钟,F值分别为3.948、16.262、8.238,均P<0.01)。两组术后第一天引流量(P>0.05)及术后声音嘶哑发生率(P>0.05)比较,差异无统计学意义,而双极电凝组低钙血症发生率(10.26%)低于电刀组(21.33%,χ²=4.353,P<0.05)。使用直型双极电凝镊可实现甲状腺手术的精细解剖。采用双极电凝镊的“微止血”和“微切割”技术可大大减少术中出血、手术时间及术后并发症。

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