超声刀Focus刀头及Ligasure Small Jaw®刀头用于开放性甲状腺手术的对照研究

摘要

背景与目的：近年来，随着技术发展，越来越多的基于能量传递的止血工具广泛问世并应用于开放性外科手术中。超声刀Focus刀头(Harmonic Focus®，HF)及Ligasure Small Jaw®刀头(LSJ)都是专为开放性甲状腺手术量身定做的。本文拟对北京协和医学院中国医学科学院肿瘤医院HF及LSJ完成的开放性甲状腺手术患者的临床资料进行病例对照分析，以期比较HF及LSJ在开放性甲状腺手术中的应用效果。探讨HF及LSJ用于开放性甲状腺手术的有效性及安全性。方法：选取本院过去1年内甲状腺癌初治患者，由同一外科医师主刀使用HF或LSJ完成甲状腺全切除＋中央区清扫术，纳入HF组100例，LSJ组104例。通过比较两组手术时间及术后第1天引流量，比较两者在甲状腺手术中应用的有效性。通过比较两组术后并发症来评估安全性。结果：有效性：HF组平均手术时间为(95.8±18.0) min，LSJ组平均手术时间为(97.8±19.1) min，差异无统计学意义(P=0.363)；术后首日引流量HF组为(35.2±20.3) mL，LSJ组为(36.3±23.8) mL，差异无统计学意义(P=0.977)。安全性：HF组出现暂时性声带麻痹者1例(1.0%)，LSJ组术后伤口出现术区血肿者1例(1.0%)；暂时性甲状旁腺功能低下者HF组18例(18.0%)，LSJ组16例(15.4%)；HF组术后首日甲状旁腺素平均下降(12.3±12.8) pg/mL，LSJ组平均下降(13.9±13.4) pg/mL；血清离子钙HF组平均下降(0.20±0.13) mg/dL，LSJ组平均下降(0.20±0.16) mg/dL，差异均无统计学意义(P均＞0.05)。结论：HF及LSJ在开放性甲状腺手术中均安全、有效，手术并发症相当。%Background and purpose:In recent years, energy-based instruments have been widely used in today’s open surgeries. Harmonic Focus® (HF) and Ligasure Small Jaw® (LSJ) are both custom-made for thyroid open surgery. This study aimed to explore the effcacy and safety of HF and LSJ in open thyroidectomy.Methods:The data from patients who undertook total thyroidectomy with central neck dissection by the same surgeon during last year in this hospital were reviewed. HF was used in 100 patients, and LSJ was used in 104 patients. The effectiveness was appraised by comparing operation time and postoperative volume of drainage on the ifrst postoperative day. The safety was appraised by comparing the incidence of postoperative complications.Results:The results of the effectiveness:the average duration of operation was (95.8±18.0) min for HF group, and (97.8±19.1) min for LSJ group, there was no statistical signiifcance (P=0.363). Postoperative volume of drainage on the ifrst postoperative day was (35.2±20.3) mL for HF group, and (36.3±23.8) mL for LSJ group, there was no statistical signiifcance (P=0.977). One patient (1.0%) had temporary vocal cord paralysis in HF and one had postoperative hematoma (1.0%) in LSJ group. Temporary hypo-parathyroidism was detected in 18 patients (18.0%) of HF group, and 16 patients (15.4%) of LSJ group. The decline of parathyroid hormone during the ifrst postoperative day was (12.3±12.8) pg/mL in HF group, and (13.9±13.4) pg/mL in LSJ group. The decline of serum calcium was (0.20±0.13) mg/dL in HF group, and (0.20±0.16) mg/dL in LSJ group. There were all no statistical signiifcances (P>0.05).Conclusion:Both HF and LSJ are safe and effective in open thy-roidectomy without similar operative complications.