超声刀联合双极电凝镊在腔镜辅助甲状腺癌手术中的应用  

Application of Ultrasonic Scalpel Combined With Bipolar Coagulation Forceps in Video-assisted Thyroidectomy for Thyroid Carcinoma

作　　者：周京安[1] 骆成玉 李洋[1] Zhou Jing’an;Luo Chengyu;Li Yang(Department of General Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China)

机构地区：[1]首都医科大学附属北京安贞医院普外科,北京100029

出　　处：《中国微创外科杂志》2022年第1期26-30,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨超声刀联合双极电凝镊在腔镜辅助甲状腺微创手术(minimally invasive video-assisted thyroidectomy,MIVAT)中的应用价值。方法回顾性分析2018年6月~2021年6月MIVAT术中快速冰冻病理证实甲状腺微小乳头状癌53例资料。前32例使用超声刀操作(超声刀组),后21例使用超声刀联合双极电凝镊(联合组)。2组年龄、性别、肿物大小以及位置均无统计学差异(P>0.05)。2组手术均由同一组医生完成。比较2组手术时间、术中出血量、术后24 h引流量、术后住院时间、中央区淋巴结清扫数量、术后并发症。结果2组手术均顺利完成,联合组术中出血量、术后24 h引流量、术后住院时间均明显少于超声刀组[(14.5±3.8)ml vs.(26.7±9.6)ml,t=-6.421,P=0.000;(21.2±6.3)ml vs.(43.0±8.0)ml,t=-10.488,P=0.000;(1.9±0.9)d vs.(3.6±1.1)d,t=-5.991,P=0.000]。术后暂时性声音嘶哑联合组0例,超声刀组3例,2组差异无统计学意义(P=0.269)。2组手术时间、中央区淋巴结清扫数量差异无统计学意义(P>0.05)。术后随访4~38个月,平均22个月,未发现肿瘤复发。结论超声刀联合双极电凝镊明显减少术中出血,降低神经损伤风险,是安全施行MIVAT甲状腺癌手术的理想工具。Objective To explore the application value of ultrasonic scalpel combined with bipolar coagulation forceps in minimally invasive video-assisted thyroidectomy(MIVAT).Methods A retrospective analysis was made on 53 cases of papillary thyroid microcarcinoma(PTMC)confirmed by intraoperative fast frozen section examination between June 2018 and June 2021.The former 32 cases underwent standard radical thyroidectomy by simply using ultrasonic scalpel(ultrasonic scalpel group).The latter 21 cases were completed by combining ultrasonic scalpel with bipolar coagulation forceps(combination group).There was no significant difference in age,gender,tumor size and tumor location between the two groups(P>0.05).Both procedures were performed by the same surgeons.The operative time,intraoperative blood loss,postoperative 24-hour drainage volume,postoperative hospitalization stay,number of dissected central lymph nodes,and postoperative complications were compared.Results All the procedures were accomplished successfully.The intraoperative blood loss,postoperative 24-hour drainage volume and postoperative hospitalization stay in the combination group were significantly less than those in the ultrasonic scalpel group[(14.5±3.8)ml vs.(26.7±9.6)ml,t=-6.421,P=0.000;(21.2±6.3)ml vs.(43.0±8.0)ml,t=-10.488,P=0.000;(1.9±0.9)d vs.(3.6±1.1)d,t=-5.991,P=0.000].There were none of postoperative transient hoarseness in the combination group and 3 cases in the ultrasonic scalpel group,without statistical difference between the two groups(P=0.269).There were no significant differences between the two groups in operative time and number of dissected central lymph nodes(P>0.05).All the patients were followed up for 4-38 months(mean,22 months).Local relapse was not observed.Conclusion Combined use of ultrasonic scalpel and bipolar coagulation forceps can significantly reduce intraoperative blood loss and decrease the risk of nerve injury,being an ideal combination of surgical energy devices for safe MIVAT for thyroid cancer.

关 键 词：超声刀 双极电凝镊 腔镜辅助甲状腺微创手术 精细化被膜解剖 外科能量器械 

分 类 号：R73[医药卫生—肿瘤]