小切口内镜下超声刀甲状腺手术的临床应用.doc

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1、小切口内镜下超声刀甲状腺手术的临床应用作者：王玉明，高迎飞，汪令成【摘要】目的探讨小切口内镜下甲状腺手术的血管离断和出、渗血控制的新方法。方法以Miccoli术式为基本框架，选择高频超声刀作为基本器械，辅以少数其他器械，对138例初诊为结节性甲状腺肿、甲状腺瘤患者行此种内镜下手术。术中按自行设计的顺序式游离-凝闭-切断方法直接离断各较粗动、静脉分、属支；按预凝闭和切吸凝分交替配合方法综合控制腺体分离过程中内断面出血。对这2种方法的安全性和有效性进行观察。结果138例患者除12例因术中冰冻报告为癌中转开放手术外，其余126例手术均顺利完成，无一例因术中出血失控或术后创口内出血再改为开放

2、手术。按顺序式游离-凝闭-切断方法操作，可以用高频超声刀直接离断较粗大的甲状腺动、静脉血管分、属支，而不必结扎或用血管夹处理血管断端。切开前先用超声刀对切口附近血管及局部被膜血管网做适当的凝闭处理，可以显著减少切开分离时的出血量。结论高频超声刀是一种适用于内镜下甲状腺手术的新型外科工具，不仅能显著提高手术安全性，而且可以大幅降低操作难度。【关键词】内镜；超声刀；甲状腺；外科手术［Abstract］ObjectiveToexplorethenewtechniqueofbleedingcontrolandvesseldividinginminimallyinvasiveendoscopi

3、cthyroidectomy.MethodsAccordingtoMiccolismodeandusingultrasonicscalpelasamajor，supplementedbyafewotherequipmentduringthewholeprocess，138caseswiththyroidgoiteroradenomareceivedtheminimallyinvasiveendoscopicthyroidectomy.Duringtheoperations，twomethods，“sequenceddissect-coagulate-cutthatdesignedb

4、yourselvestodividevesseldirectlyandpre-coagulation，cut-suck-coagulate-dissectinterlacedtocontrolbleedingofoperationsections”wereseparatelyevaluatedfortheirsafetyorefficacy.Results138cases，inadditionto12caseswhosefrozensectionweremalignantconvertedtoopenthyroidectomy，theremaining126caseswerecomp

5、letedsuccessfully.Noneofthemwereinterruptedandconvertedtoopensurgeryduetouncontrollingbleedingorseverepostoperativehematoma.Branchesofmajorthyroidvesselscanbedirectlydividedbyultrasonicscalpelwithoutligationorusinghemoclips，supposingthetechniqueof“sequenceddissect-coagulate-cut”methodwasstrictl

6、yused.Bleedingduringintra-glanddissectioncanbeeffectivelycontrolledbythecombinedtechniquesofprecoagulationofthevesselsandthecapsulevesselnetworknearandaroundtheincision，andthen，bycoordinatingmanipulationwithaspecialmultiplefunctionalultrasonicscalpelanda5suction-dissector，supposingthetechniqueo

7、f“interlacedcut-suck-coagulate-dissect”wasproperlyemployed.ConclusionUltrasonicscalpelisanewsurgicaltoolappliedtoendoscopicthyroidectomy.Theclinicalapplicationofultrasonicscalpelandendoscopenotonlyimprovethesafetyofsurgerysignific