经胸前壁入路腔镜甲状腺手术皮肤烧伤的预防与处理  

Prevention and management of skin burn in endoscopic thyroidectomy via upper anterior thoracic approach

作　　者：陈海波 林信斌 

机构地区：[1]浙江省温岭市第一人民医院甲状腺外科,317500

出　　处：《中华全科医师杂志》2018年第3期216-217,共2页Chinese Journal of General Practitioners

摘　　要：回顾分析10年间行经胸前壁入路腔镜甲状腺手术发生皮肤烧伤的21例[7.8%（21/268）]患者的临床资料。烧伤原因：建腔时分离层次过浅9例（43%）；发生皮瓣出血时盲目烧灼止血11例（52%）；越过胸锁乳突肌外侧范围分离不当1例（5%）。术后皮下瘀斑、皮肤水疱样烧伤12例（57%）愈合后无色素沉着；皮肤烧伤坏死3例（14%）行清创、换药处理后愈合，有瘢痕增生；皮肤烧伤破溃术中修整坏死皮肤后皮内缝合4例（19%）一期愈合，瘢痕不明显；2例（10%）破溃处术中置管，换药处理后愈合，有明显瘢痕增生。提示建腔时掌握正确层次或发生皮瓣出血时恰当处理可预防皮肤烧伤，恰当处理皮肤烧伤可减少皮肤瘢痕。Total 268 patients underwent endoscopic thyroidectomy via upper anterior thoracic approach in Wenling First People＇s Hospital from June 2005 to July 2015, and skin burn occurred in 21 cases （7. 8% ）. The causes of skin burns were shallower level of built space in 9 cases （43%）, mismanagement for skin bleeding in 11 cases （52%） , and improper separation of sternocleidomastoid region in 1 case （5%）. After management 12 cases of subcutaneous ecchymosis or blisters （57%） were healed without pigmentation, 3 cases of skin necrosis （ 14% ） were healed with scars, 4 cases of burned skin rupture treated with intradernlal suture （ 19% ） were healed by first intension and with minor scars, 2 cases of burned skin rupture treated with catheter drainage （ 10% ） were healed with obvious scars. The resuhs show that correct level of puncture and proper management of skin bleeding can prevent skin burn, and proper treatments of skin burn can reduce the skin scars.

关 键 词：内窥镜检查 甲状腺切除术 烧伤 电 皮肤 

分 类 号：R653[医药卫生—外科学]