创面应用医用透明质酸钠预防经胸乳入路腔镜甲状腺手术后颈胸部皮肤粘连及疼痛的研究  

Clinical study about the prevention of the skin scar adhesions and pain by using sodium hyaluronate at wound in endoscopic thyroidectomy via breast approach

作　　者：赖勇强[1] 梁伟新[1] 苏秀梅[1] 黄尚书[1] 朱明章[1] 李志宏[1] LAI Yongqiang;LIANG Weixin;SU Xiumei;HUANG Shangshu;ZHU Mingzhang;LI Zhihong(Department of General Surgery,Affiliated Gaoming Hospital of Guangdong Medical University,Foshan 528500,China)

机构地区：[1]广东省佛山市高明区人民医院普外科

出　　处：《岭南现代临床外科》2019年第4期429-432,436,共5页Lingnan Modern Clinics in Surgery

基　　金：佛山市医学类科技攻关项目(2016AB001264)

摘　　要：目的探讨经胸乳入路腔镜甲状腺手术中,创面应用医用透明质酸钠凝胶(HA)对患者术后疼痛和皮肤疤痕粘连的预防效果。方法将102例行甲状腺手术的患者按照自愿原则分为4组:腔镜甲状腺手术并创面应用HA组(腔镜+HA组)、腔镜组、传统开放手术并应用HA组(开放+HA组)和开放组。观测各组手术时间、术后48 h切口引流量,记录术后6 h、24 h伤口VAS疼痛评分及止痛药使用例次。记录手术并发症情况。记录术后3个月患者局部皮肤感觉异常情况、皮肤瘢痕粘连程度轻、中、重度)。结果各组均顺利完成手术,除腔镜+HA组、开放+HA组各有一例不完全性喉返神经损伤外,无其他严重并发症发生。比较分析示,腔镜甲状腺手术组耗时长于传统开放手术组;而术后48 h引流量、术后6 h和24 h切口疼痛VAS评分、止痛药使用例数,各组间差异均无统计学意义。随访3个月,合并局部皮肤感觉异常的例数,各组间的差异无统计学意义。疤痕粘连严重程度比较,腔镜组与开放组差异无统计学意义,但分别应用HA后,中、重疤痕粘连的比例减少,差异具统计学意义(P<0.05)。结论经胸乳入路腔镜甲状腺手术,术中创面应用HA,并不减轻术后患者的疼痛感受,但是可有效地减轻术后皮肤疤痕粘连的发生和程度。Objective To investigate the preventive effect of Sodium Hyaluronate(HA)on postoper-ative pain and skin scar adhesion in patients underwent endoscopic thyroidectomy via breast approach.Methods According to patients′choice,102 patients with thyroid diseases who needed surgical treat-ment in our hospital were divided into 4 groups:endoscopic thyroidectomy and using HA group(endo-scopic+HA group),endoscopic group,conventional open surgery and using HA group(open+HAgroup)and open group.The operation time,the drainage volume in 48 h,VAS pain scores of wounds at6 h and 24 h postoperatively,and the numbers of analgesics using patients in each group were recorded.Follow up 3 months after surgery,estimated if patients got skin paraesthesia,and skin scar adhesion(degree of light,moderate and severe).Results Operations of groups were successfully completed.There were no serious complications except each one case of incomplete recurrent laryngeal nerve injuryin the Endoscopic+HA group and Open+HA group.According to the comparative analysis,the Endo-scopic group took longer time than the Open group.However,the drainage volume in 48 h,VAS painscores of wounds at 6 h and 24 h postoperatively,and the numbers of analgesics using patients among the groups had no significantly differences.Follow?up 3 months,the numbers of patients with skin paraes?thesia among 4 groups had no significant differences.Totally there was no significant difference in the severity of scar adhesions between Endoscopic group and Open group.However,after using HA in both endoscopy group and open group,the cases of moderate and severe skin scar adhesions were decreased obviously,and the differences were statistically significant.Conclusion By using HA,the wound pain won′t be lightened in patients after endoscopic thyroidectomy via breast approach,but it could effectively reduce the occurrence and degree of postoperative skin scar adhesions by following up 3 months.

关 键 词：医用透明质酸钠 腔镜甲状腺手术 疼痛 粘连 

分 类 号：R653[医药卫生—外科学]