超声刀在甲状腺癌颈淋巴结清扫术中的应用研究(1)
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[摘要] 目的:探讨甲状腺癌颈淋巴结清扫中应用超声刀行清扫术与传统手术的优、缺点。方法：收集2009年至2010年间我院同一手术小组完成甲状腺癌颈清扫术55例,分为超声刀组(29例)和传统组(26例)。超声刀组行超声刀甲状腺癌颈淋巴结清扫术，传统组行传统淋巴结清扫术，分别比较两组的总手术时间、切除甲状腺时间、术后引流量及手术并发症的发生情况。结果：两组患者在性别、年龄方面差异无统计学意义(P>0.05)。超声刀组的总手术时间、切除甲状腺时间和术后引流量均小于传统组(P<0.05)；两组术后暂时性甲状旁腺功能低下和喉返神经麻痹发生率差异无统计学意义(P>0.05),均无永久性甲状旁腺功能低下、喉返神经麻痹及术后出血病例。结论：用超声刀行甲状腺癌颈清扫术安全可靠,而且可缩短手术时间,减少术后引流量,减少手术并发症的发生，从而减少创伤,值得在临床中进行推广。
[关键词] 超声刀; 颈淋巴结清扫术; 甲状腺癌
[中图分类号] R736.1 [文献标识码] A [文章编号] 1671-7256(2011)02-0175-04
doi：10.3969/j.issn.1671-7256.2011.02.016
Harmonic scalpel in cervical lymph node dissection of thyroid cancer
FAN Yu-wen, ZHANG Yuan, ZHAO Wei-ping, YU Tong-hua, LIU Fang-zhou
(Department of Head and Neck Surgery, Jiangsu Province Tumor Hospital, Nanjing 210009， China)
[Abstract] Objective: To compare the disadvantage and advantage of cervical lymph node dissection of thyroid cancer using the harmonic scalpel vs conventional hemostasis. Methods: Twenty-nine and twenty-six patients underwent thyroid surgery with harmonic scalpel or conventional hemostasis respectively.The total operative time, thyroidectomy time, postoperative drainage volume and surgical complications were compared. Results: There was no significant different of age and gender between the harmonic scalpel and conventional hemostasis group. Total operative time, thyroidectomy time, and postoperative drainage volume in harmonic scalpel group were significantly lower than those of conventional hemostasis group(P<0.05); the surgical complications showed no significant difference between the harmonic scalpel group and conventional hemostasis group(P>0.05). Conclusion: Harmonic scalpel provides significant advantages over conventional hemostasis in cervical lymph node dissection of thyroid cancer.
[Key words] harmonic scalpel; cervical lymph node dissection; thyroid cancer
因颈部解剖复杂、周围重要神经血管较多,甲状腺癌颈淋巴结清扫术一直是一种具有很高难度的精细手术。在传统手术中多以钳夹和结扎来达到术中止血目的,但耗时较多,并存在一定的不良反应。近几年来,超声刀作为一种新型手术器械,因其集切割和止血于一体,已广泛应用于临床外科手术领域,同时在头颈外科手术中也逐步推广。我们以超声刀行甲状腺癌根治术与传统手术方式进行分析比较,探讨超声刀在甲状腺癌颈淋巴结清扫术中的应用价值。
1 资料和方法
1.1 一般资料
收集我院头颈外科2009年1月至2010年10月行甲状腺癌颈淋巴结清扫术的病例55例,其中使用超声刀完成该手术者29例(超声刀组)，采用传统手术方式者26例(传统组)。超声刀组：男8例,女21例；年龄12~74岁,平均41岁。手术方式为一侧甲状腺腺叶及峡部切除并颈部淋巴结清扫。根据颈部淋巴结清扫范围分为单侧Ⅵ区清扫、双侧Ⅵ区清扫及功能性颈部淋巴结清扫(Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ区)清扫 ......
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