普通电刀钳夹凝闭技术在兔甲状腺切除术中的应用效果及安全性  

Effect and safety of common electric knife clamp coagulation technique in thyroidectomy in rabbits

作　　者：李婷婷 李珊 侯栋 宋阳 王艺豪 王雷[1] 薛会朝[1] LI Tingting;LI Shan;HOU Dong;SONG Yang;WANG Yihao;WANG Lei;XUE Huichao(Department of General Surgery,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China)

机构地区：[1]新乡医学院第一附属医院普外科,河南卫辉453100

出　　处：《新乡医学院学报》2024年第3期209-213,共5页Journal of Xinxiang Medical University

基　　金：河南省高等学校重点科研项目(编号:21A320021)。

摘　　要：目的探讨普通电刀钳夹凝闭技术在兔甲状腺切除术中的应用效果及安全性。方法按照随机数字表法将12只新西兰兔分为钳夹凝闭组和超声刀组,每组6只。钳夹凝闭组兔行普通电刀钳夹凝闭技术离断甲状腺中部,超声刀组兔行超声刀电凝离断甲状腺中部。观察2组兔术后一般情况。取切除后甲状腺组织行苏木精-伊红(HE)染色,光学显微镜下观察热损伤后甲状腺组织病理学,并测定热损伤范围;分别于术后第1、3、7天,抽取2组兔的耳缘静脉血,应用酶联免疫吸附测定法检测血清中白细胞介素-6(IL-6)、C反应蛋白(CRP)水平;术后第7天,处死2组兔,取残余甲状腺,行HE染色,光学显微镜下观察病理学变化及炎症细胞浸润情况。结果2组兔术后均存活良好,术区愈合良好,残腔未见明显积液、凝血块,无术后出血、切口感染等并发症。光学显微镜下,甲状腺切缘表面可见明显损伤区域;损伤区域部分细胞结构受损,出现凝固性坏死,部分滤泡破裂,内容物呈固体浓缩和深染;滤泡旁细胞的胞质嗜酸性增加,核固缩、碎裂,甚至核溶解。超声刀组和钳夹凝闭组兔甲状腺组织的热损伤范围分别为(0.72±0.10)、(0.88±0.11)mm;钳夹凝闭组兔甲状腺组织的热损伤范围显著大于超声刀组(t=-2.740,P<0.05)。术后第1、3、7天,钳夹凝闭组与超声刀组兔血清中CRP、IL-6水平比较差异无统计学意义(P>0.05);2组兔术后第1、3、7天血清中CRP水平比较差异无统计学意义(P>0.05);2组兔术后第3、7天血清中IL-6水平显著高于术后第1天(P<0.05);术后第3天与第7天血清中IL-6水平比较差异无统计学意义(P>0.05)。2组兔的残余甲状腺断面均可见部分甲状腺腺体滤泡萎缩,胶质减少,滤泡上皮增生,间质纤维胶原化、增生,未见明显的炎症细胞浸润。结论在兔甲状腺切除术中应用普通电刀钳夹凝闭技术离断甲状腺较为安全;在预防热损伤方面,超Objective To investigate the effect and safety of common electric knife clamp coagulation technique in rabbit thyroidectomy.Methods According to the random number table method,12 New Zealand rabbits were divided into the clamp coagulation group and the ultrasonic scalpel group,with 6 rabbits in each group.The middle part of the thyroid gland in the clamp coagulation group was severed by common electric knife clamp coagulation,while that in the ultrasonic scalpel group was severed by ultrasonic scalpel electrocoagulation.The postoperative conditions of rabbits in the two groups were observ.The severed thyroid tissue was stained with hematoxylin-eosin(HE),and its histopathology after thermal damage was observed under the light microscope.The scope of thermal damage was determined.On the 1 st,3 rd and 7 th day after operation,the auricular venous blood of all rabbits was collected to assess the serum interleukin-6(IL-6)and C-reactive protein(CRP)levels by enzyme-linked immunosorbent assay.The rabbits were killed on the 7 th day after operation,and the residual thyroid glands were removed and stained by HE.The pathological changes and inflammatory cell infiltration were observed under the light microscope.Results The rabbits in the 2 groups survived well after operation,and the operative area healed well.No obvious effusion,blood clot,bleeding,incision infection or other complications were found in the residual cavity.Under the light microscope,the surface of the incisal margin of the thyroid gland showed obvious lesions.In the injured area,some cell structures were damaged with coagulated necrosis,some follicles were ruptured,and the contents inside were solidly concentrated and deeply stained.The cytoplasmic eosinophils in parafollicular cells increased,and nuclear pyknosis,fragmentation,and even dissolution occurred.The thermal damage ranges of thyroid tissues in the ultrasonic scalpel and clamp coagulation groups were(0.72±0.10)mm and(0.88±0.11)mm,respectively.The range of thermal damage in the clamp coagulatio

关 键 词：钳夹凝闭技术 超声刀 甲状腺切除 热损伤 

分 类 号：R653[医药卫生—外科学]