周韜 莊亞強(qiáng) 曹一鳴 等

[摘要] 目的 探討雙極電凝系統(tǒng)與超聲刀在精細(xì)被膜解剖下甲狀腺手術(shù)中的應(yīng)用效果。 方法 將2015年1月～2016年12月在我院外科擬行甲狀腺手術(shù)的112例患者隨機(jī)平均分為觀察組和對照組兩組，觀察組為超聲刀與雙極電凝組，使用超聲刀與雙極電凝鑷進(jìn)行精細(xì)被膜解剖甲狀腺手術(shù)，對照組為傳統(tǒng)手術(shù)組，即使用高頻電刀配合傳統(tǒng)絲線結(jié)扎行甲狀腺手術(shù)，比較兩組患者的各項(xiàng)手術(shù)指標(biāo)、并發(fā)癥發(fā)生率、甲狀旁腺激素及血清鈣離子水平。 結(jié)果 觀察組切口長度、手術(shù)時(shí)間、住院時(shí)間、術(shù)中出血量、術(shù)后術(shù)區(qū)引流量均明顯少于對照組（P<0.05）;觀察組術(shù)后皮瓣下積液、喉返神經(jīng)暫時(shí)性或永久性麻痹、暫時(shí)性或永久性甲狀旁腺功能低下等并發(fā)癥發(fā)生率明顯低于對照組（P<0.05）;觀察組術(shù)后1 d、術(shù)后1周的甲狀旁腺激素水平明顯高于對照組，觀察組術(shù)后1 d的血清鈣離子水平明顯高于對照組（P<0.05），而兩組術(shù)后1周的血清鈣離子水平無明顯差異（P>0.05）。 結(jié)論 雙極電凝系統(tǒng)與超聲刀在精細(xì)被膜解剖下甲狀腺手術(shù)中的應(yīng)用效果顯著，提高甲狀腺手術(shù)的質(zhì)量和安全性，減少手術(shù)并發(fā)癥的發(fā)生，提高治愈率、減輕患者的痛苦。

[關(guān)鍵詞] 甲狀腺手術(shù);雙極電凝系統(tǒng)與超聲刀;精細(xì)被膜解剖;應(yīng)用效果

[中圖分類號] R653? ? ? ? ? [文獻(xiàn)標(biāo)識碼] B? ? ? ? ? [文章編號] 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.