摘要
目的探讨手术刀和超声刀联合应用在腔镜辅助甲状腺手术Berry韧带解剖中的安全性和可行性。方法2017年6月～2018年7月,采用随机对照研究,将腔镜辅助单侧甲状腺叶加峡部切除、同侧中央区淋巴结清扫术中Berry韧带解剖分为单纯应用超声刀组(A组)与联合应用手术刀和超声刀组(B组)各31例,比较2组术后嗓音障碍指数评分、喉返神经损伤发生率、手术时间、Berry韧带解剖时间、术中出血量和术后引流量等指标的差异。结果喉返神经损伤发生率A组明显多于B组[25. 8%(8/31) vs. 3. 2%(1/31),χ~2=4. 679,P=0. 031],Berry韧带解剖时间A组明显短于B组[中位数5. 0(2～10) min vs. 7. 0(1～16) min,Z=-2. 346,P=0. 019]。2组手术时间[(63. 5±11. 6) min vs.(66. 2±15. 4) min,t=0. 773,P=0. 442]、术中出血量[(12. 9±7. 8) ml vs.(13. 5±5. 7) ml,t=0. 372,P=0. 711]、术后引流量[(46. 9±19. 3) ml vs.(41. 9±16. 5) ml,t=-1. 097,P=0. 277]、术后3天嗓音障碍指数评分[2. 0(0～20) vs. 2. 0(0～13),Z=-0. 661,P=0. 509]和清扫淋巴结数目[6. 0(3～18) vs. 6. 0(2～18),Z=-1. 276,P=0. 202]均无统计学差异。结论腔镜辅助甲状腺叶切除术中联合应用手术刀和超声刀解剖Berry韧带能够减少喉返神经热损伤。
Objective To evaluate the safety and feasibility for dissecting Berry ligament by the combined application of scalpel and harmonic scalpel.Methods From June 2017 to July 2018, a randomized controlled trial was performed during minimally invasive video-assisted unilateral lobectomy and ipsilateral central lymph node dissection.The patients were randomly divided into either simple application of the ultrasonic scalpel group ( group A) or the combined application of scalpel and ultrasonic scalpel group ( group B), with 31 cases in each group.Differences in the postoperative voice handicap index score, incidence of recurrent laryngeal nerve injury, operative time, dissection time of Berry ligament, intraoperative blood loss, and postoperative drainage were compared between the two groups.Results The incidence of recurrent laryngeal nerve injury was significantly higher in the group A than that in the group B [25.8%(8 /31) vs.3.2%(1 /31),χ^2 = 4.679, P = 0.031].The dissection time of Berry ligament was significantly shorter in the group A than that in the group B [ median 5.0 (2 - 10) min vs.7.0 (1 - 16) min, Z =- 2.346, P = 0.019].The differences in the operative time [(63.5 ± 11.6) min vs.(66.2 ± 15.4) min, t = 0.773, P = 0.442], intraoperative blood loss [(12.9 ± 7.8) ml vs.(13.5 ± 5.7) ml, t = 0.372, P = 0.711], postoperative drainage [(46.9 ± 19.3) ml vs.(41.9 ± 16.5) ml, t =- 1.097, P = 0.277], postoperative voice handicap index score [2.0 (0 - 20) vs.2.0 (0 - 13), Z =- 0.661, P = 0.509] and number of dissected lymph nodes [6.0 (3 - 18) vs.6.0 (2 - 18), Z =- 1.276, P = 0.202] were not statistically significant.Conclusion Combined application of scalpel and harmonic scalpel in minimally invasive video-assisted thyroidectomy is safe and feasible, which reduces the incidence of thermal injury.
作者
闫斌斌
贺晨宇
贺建业
侯迎晨
Yan Binbin;He Chenyu;He Jianye(Department ofGeneral Surgery, Beijing Institute ofHeart Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China)
出处
《中国微创外科杂志》
CSCD
北大核心
2019年第4期298-302,共5页
Chinese Journal of Minimally Invasive Surgery
基金
北京市科学技术委员会生物医药与生命科学创新培育研究(Z15110200390000)
关键词
手术刀
超声刀
Berry韧带
喉返神经损伤
Scalpel
Harmonic scalpel
Berry ligament
Recurrent laryngeal nerve injury
