双极电凝系统与超声刀在精细被膜解剖下甲状腺手术中的应用效果

周韬 庄亚强 曹一鸣 等

[摘要] 目的 探討双极电凝系统与超声刀在精细被膜解剖下甲状腺手术中的应用效果。 方法 将2015年1月～2016年12月在我院外科拟行甲状腺手术的112例患者随机平均分为观察组和对照组两组，观察组为超声刀与双极电凝组，使用超声刀与双极电凝镊进行精细被膜解剖甲状腺手术，对照组为传统手术组，即使用高频电刀配合传统丝线结扎行甲状腺手术，比较两组患者的各项手术指标、并发症发生率、甲状旁腺激素及血清钙离子水平。 结果 观察组切口长度、手术时间、住院时间、术中出血量、术后术区引流量均明显少于对照组（P<0.05）;观察组术后皮瓣下积液、喉返神经暂时性或永久性麻痹、暂时性或永久性甲状旁腺功能低下等并发症发生率明显低于对照组（P<0.05）;观察组术后1 d、术后1周的甲状旁腺激素水平明显高于对照组，观察组术后1 d的血清钙离子水平明显高于对照组（P<0.05），而两组术后1周的血清钙离子水平无明显差异（P>0.05）。 结论 双极电凝系统与超声刀在精细被膜解剖下甲状腺手术中的应用效果显著，提高甲状腺手术的质量和安全性，减少手术并发症的发生，提高治愈率、减轻患者的痛苦。

[关键词] 甲状腺手术;双极电凝系统与超声刀;精细被膜解剖;应用效果

[中图分类号] R653          [文献标识码] B          [文章编号] 1673-9701（2019）05-0051-03

[Abstract] Objective To investigate the application effect of bipolar electrocoagulation system and ultrasonic scalpel in thyroid surgery under fine capsule anatomy. Methods A total of 112 patients undergoing thyroid surgery in our hospital from January 2015 to December 2016 were randomly divided into group A and group B. Group A was ultrasonic scalpel and bipolar coagulation group， and was treated with ultrasonic scalpel and bipolar electrocoagulation tweezers for fine capsule anatomy in thyroid surgery. Group B was traditional operation group， and treated with high-frequency electrosurgical knives and traditional silk ligature for thyroid surgery. The surgical indexes， complication rate， parathyroid hormone and serum calcium level between the two groups were compared. Results The length of incision， operation time， hospitalization time， intraoperative blood loss， and postoperative drainage volume in group A were significantly less than those in group B（P<0.05）. The incidence of complications such as postoperative subcutaneous effusion， temporary or permanent paralysis of recurrent laryngeal nerve， temporary or permanent hypoparathyroidism in group A was significantly lower than that of group B（P<0.05）. The level of parathyroid hormone in group A at 1 day after surgery and 1 week after surgery was significantly higher than that in group B. The blood calcium level in group A was significantly higher than that in group B at 1 day after surgery（P<0.05）. But there was no significant difference in blood calcium level between the two groups（P>0.05）. Conclusion The application of bipolar electrocoagulation system and ultrasonic scalpel in thyroid surgery under fine capsule anatomy has significant effect， which can improve the quality and safety of thyroid surgery， reduce the occurrence of surgical complications， improve the cure rate and alleviate the suffering of patients.