手术治疗甲状腺疾病980例护理体会

目的总结手术治疗甲状腺疾病的经验.方法回顾分析980例患者的临床资料,讨论术中及术后处理的要点.结果囊内结扎切除法使喉返神经损伤率明显降低;细管负压引流可保持切口清洁,使引流更加彻底;切口皮内缝合法或医用胶粘合法增强了美容效果并可缩短住院时间.结论手术治疗甲状腺疾病可获得良好效果.     

改良小切口甲状腺腺叶切除治疗甲状腺良性疾病疗效观察

目的:探讨改良小切口甲状腺腺叶切除术在甲状腺良性疾病治疗中的临床效果。方法:选取2015年10月～2017年5月我院收治的114例甲状腺良性疾病患者作为研究对象,根据术式的不同分为观察组与对照组,每组57例。对照组行传统开放式甲状腺腺叶切除术;观察组行改良小切口甲状腺腺叶切除术。比较两组的手术情况、术后恢复情况、术后并发症发生率和术后1年的复发率。结果:观察组的切口长度短于对照组,术中出血量和术后引流量少于对照组,颈部活动恢复时间和住院时间均短于对照组,差异均有统计学意义,P0.05;两组的手术用时相比较,差异无统计学意义,P0.05;观察组的并发症发生率为7.02%,低于对照组的21.05%,差异有统计学意义,P0.05;随访至术后1年,两组的复发率相比较,差异无统计学意义,P0.05。结论:改良小切口甲状腺腺叶切除术治疗甲状腺良性疾病,具有微创优势,手术切口小,术中出血少,并发症发生率低,利于早期康复,缩短住院时间,且不会增加疾病复发风险。     

甲状腺手术放置引流管的改进

甲状腺疾病为常见多发病，常需要手术处理。病灶部位手术完毕必须常规按置引流，达到引流手术野渗（出）血目的，从而防止甲状腺术后渗（出）血积聚引起致命窒息及防止血肿形成引起术后感染、切口愈合不良。传统的引流方法为切口两侧置胶片至两甲状腺窝，经切口或切口下缘戳孔置胶管于甲状腺窝㈦。前者达不到通畅、彻底引流的要求，后者虽然通畅引流较好，但没有负压持续吸引，离彻底引流的要求还有差距。按照外科引流的通畅、彻底、对组织损伤干扰小，顺应解剖生理要求的原则。     

腔镜下小切口甲状腺手术在甲状腺良性肿瘤疾病治疗中的运用价值

目的腔镜下小切口甲状腺手术在甲状腺良性肿瘤疾病治疗中的运用价值探析。方法选取我院2016年8月～2017年8月所接收的甲状腺良性肿瘤患者60例,按随机数字表法均分成观察组和对照组各30例。观察组采取腔镜下小切口甲状腺手术,对照组采取传统甲状腺手术。对两组患者的手术治疗效果、术后并发症以及术后1年复发率等情况进行对比与分析。结果观察组患者的术中出血量、切口长度、手术时间、术后引流量、拔管时间、住院时间等指标均优于对照组患者,差异有统计学意义(P0.05);观察组术后并发症发生率为6.7%,明显低于对照组的20.0%,差异有统计学意义(P0.05);观察组患者术后1年复发率为3.3%,与对照组6.7%比较,差异无统计学意义(P0.05)。结论对甲状腺良性肿瘤疾病予以腔镜下小切口甲状腺手术治疗,疗效甚佳,可降低并发症发生率,值得推广。     

甲状腺术后引流方法的改进

甲状腺疾病为常见多发病,常需要手术处理[1]。手术完毕一般需常规放置引流,以引流创面渗液和观察创面有无活动性出血等情况[2],从而防止术后渗血、出血积聚所引起的致命窒息,以及防止血肿形成引起术后切口感染、愈合不良。传统的引流方法有:(1)     

密闭式负压引流球在甲状腺手术中的应用

总结了156例密闭式负压引流球在甲状腺手术中的应用,包括其优点及术后注意事项,优点主要有:颈部切口引流通畅彻底、预防切口感染、护理上省时简单、术后患者携管活动方便,而术后注意事项主要是要加强病情观察。认为甲状腺手术中使用密闭式负压引流球,减少了切口感染的机会,减轻了护士的工作量,有利于促进患者恢复。     

改良Miccoli术式内镜甲状腺手术的安全护理改进

手术切除是甲状腺疾病的主要治疗方法,传统甲状腺手术都会在患者颈部留下一条很长的瘢痕。经前颈部单一小切口入路机械牵张法成腔内镜或内镜辅助下行甲状腺手术,是一种新的微创甲状腺手术术式,由意大利医生Miccoli最早提出[1],本院对经典的Miccoli术式进行了改良和创新,使该术式的操作难度大幅下降、手术适应证扩大、手术安全性和微创美容效果提高,并命名为改     

改良小切口手术与传统手术在甲状腺腺瘤患者中的治疗效果对比研究

目的:对比改良小切口手术方法与传统手术方式在甲状腺腺瘤患者中的治疗结果、手术经验。方法:选取2016年8月至2018年12月在我院术前经超声、CT及穿刺活检证实的甲状腺腺瘤患者90例,依随机数字表法分为改良小切口组、传统切口组各45例,分别实施传统手术切口及改良小切口手术治疗。对比两组患者的手术疗效、术后并发症发生情况及临床治疗效果。结果:两组患者病变均完整切除,改良小切口组患者手术时间与住院天数明显低于传统切口组,患者切口瘢痕长度、切口美观满意度、术中出血量、术后疼痛程度显著优于传统切口组,术后随访慢性疼痛、颈部紧缩、吞咽不适的发生率较传统切口组低(P0.05)。术后并发症发生率与传统切口组无明显差别(P0.05)。结论:甲状腺腺瘤患者采用改良小切口手术治疗可有效缩短手术及住院时间,术中出血量少,切口美观,术后疼痛轻,并发症少,值得临床推广。     

胸乳入路腔镜甲状腺手术与传统手术的临床效果比较

目的比较胸乳入路腔镜甲状腺手术及传统手术两种方式治疗良性甲状腺疾病的临床效果。方法选取2014年7月-2019年12月河北省人民医院腺体外科行甲状腺手术的患者106例,分为腔镜组(n=53)与传统组(n=53)。比较两组患者手术时间、术中出血量、术后引流量、引流时间、术后住院天数、术后止痛药需求和手术并发症发生率。结果两组患者术中出血量、术后住院天数、术后止痛药需求和手术并发症发生率比较,差异均无统计学意义(P 0.05)。腔镜组手术时间和引流时间较传统组长,术后引流量较传统组多,两组比较,差异均有统计学意义(P 0.05)。结论胸乳入路腔镜甲状腺手术治疗良性甲状腺疾病在手术安全性、可行性方面与传统手术无明显差别;但手术时间长,引流量多,且引流时间较传统手术长。     

改良小切口术式与传统术式治疗甲状腺良性肿瘤疗效分析

目的探讨改良小切口术式与传统术式治疗甲状腺良性肿瘤的临床效果。方法 90例甲状腺良性肿瘤患者象,按随机数字表法分为对照组(实施传统手术治疗)和观察组(实施改良小切口术治疗)各45例,观察两组手术时间、术中出血量、引流管留置时间、住院时间、围术期视觉模拟疼痛评分(VAS)、反流症状指数量表(RSI)评分、手术安全性,并随访术后1年甲状腺肿瘤复发率。结果观察组手术时间、住院时间、术中出血量、术后引流量少于对照组;术后6、12、24 h的VAS评分低于对照组(P0.05)。术后3个月两组RSI评分明显降低,且观察组低于对照组(P0.05);观察组术后并发症发生率低于对照组(P0.05)。结论改良小切口术式在甲状腺良性肿瘤治疗中,在优化手术一般情况、减轻患者术中疼痛度、临床效果、手术安全性方面较传统术式更具优势。     

甲状腺肿瘤217例手术治疗

目的探讨颌面外科医生手术治疗甲状腺肿瘤疾病的疗效。方法回顾收治并行手术切除的217例甲状腺包块的患者,对甲状腺手术治疗的风险、治疗效果和并发症进行分析。结果本组患者中有58例行甲状腺部分切除术,146例行甲状腺次全切术,13例行一侧腺叶切除＋峡部切除术。217例患者中术后有3例出现暂时性喉返神经损伤症状,1例伤口感染,2例甲状腺癌术后两年复发,其余病例均未出现喉返神经、喉上神经损伤、甲状腺、甲状旁腺功能低下等症状。结论颌面外科医生可以有效治疗不同甲状腺疾病。     

超声引导微波消融与手术切除甲状腺良性结节的对照观察

目的:观察超声引导微波消融与手术切除在甲状腺良性结节中的应用价值。方法:选取2015年10月-2018年10月我院接收的54例甲状腺良性结节患者,其中27例为消融术患者,为观察组;27例为手术患者,为对照组。结果:两组治疗相关指标、并发症发生率、生活质量评分的比较差异显著(P<0.05)。结论:超声引导微波消融可缩短甲状腺良性结节的手术和住院时间,降低治疗后并发症发生率,提高患者的生活质量,临床应用价值显著。     

老年大肠癌116例临床特点及外科治疗体会

目的:探讨老年大肠癌临床特点及外科治疗的有关问题。方法:回顾性分析2000年1月～2006年1月116例70岁以上行外科治疗的大肠癌患者临床资料。结果:老年大肠癌发病率有逐年上升趋势,以中晚期病例居多,因临床表现不典型易误诊,误诊率达62.1%。本组肠梗阻发生率11.2%,67.2%的有1种以上并存病。115例行手术治疗,根治性切除率70.4%,术后并发症发生率35.7%,无手术死亡病例。结论:手术切除是老年大肠癌的理想治疗方法,虽然并存病增加了手术风险,但术前全面了解病情,加强围手术期处理,可提高手术成功率、降低并发症发生率。     

桥本病合并其他甲状腺疾病的诊断和治疗

目的：探讨桥本病合并其他甲状腺疾病的诊断和手术治疗方法。方法：总结分析本院30例桥本病合并其他甲状腺疾病的临床资料。结果：术前确诊率为23%（7/30）;术中冰冻切片确诊率为100%（20/20）。30例均行手术。其中峡部切除术2例,单侧部分切除术3例。单侧次全切除术3例,双侧部分切除术5例,双侧次全切除术13例。根治术4例。术后发生甲状腺机能减退4例。结论：桥本病合并其他甲状腺疾病术前诊断困难。术中冰冻切片检查是获得正确诊断的可靠方法。并可指导手术方式的选择。     

甲状腺癌双侧颈淋巴结清扫术16例临床观察

目的探讨甲状腺癌双侧颈淋巴结清扫术的疗效。方法回顾性分析2001～2006年收治16例甲状腺癌患者资料。双侧甲状腺癌5例和峡部甲状腺癌1例者行甲状腺次全切除，10例单侧甲状腺癌均行患侧甲状腺叶及峡部全切除，所有病例均行功能性双侧颈淋巴结清扫术。结果12例双侧有淋巴结转移，4例一侧有淋巴结转移；5例术后出现一过性甲状旁腺功能低下，补钙后缓解，5周后恢复正常；2例颜面水肿，3周内消退。无喉返神经麻痹等严重并发症。随访1—6年，2例死亡。其余病例均健在。结论甲状腺癌进行同期功能性颈淋巴结清扫术在保证手术彻底性的同时，最大限度地保留机体功能，安全性高且不增加手术并发症，可提高患者的生存率和生存质量。     

高龄结、直肠癌102例临床诊治分析

目的：探讨高龄结、直肠癌病人外科治疗方法。方法：回顾性分析1995年1月～2003年12月102例70岁以上高龄结、直肠癌病人的外科治疗资料。结果：高龄结、直肠癌病人入院前误诊率高(48．1％)，并存病多(53．8％)，术后并发症发生率为31.7％，围手术期死亡率为4．2％。结论：手术切除是高龄结、直肠癌病人最好的治疗方法。早期诊断，早期治疗，合理处理并存病，充分的肠道准备，适当的手术方式，有效地预防和治疗并发症是提高疗效的关键。     

Total thyroidectomy for the treatment of thyroid diseases in an endemic area

INTRODUCTION: Thyroidectomy is a common operation with very low mortality and an acceptable morbidity rate. Total thyroidectomy has become the predominant type of surgery used today for the treatment of thyroid diseases. In this retrospective study, we analyzed the complications of thyroid surgery according to the operative technique used in our department. MATERIAL AND METHODS: A retrospective analysis was performed for all patients who underwent thyroid surgery during the previous 11 years. The period under study was divided into two sections: phase A (1995-1999) and phase B (2000-2005). Patient characteristics, type of operation, histologic diagnoses and postoperative complications were compared in the two study periods according to the type of surgery. RESULTS: A total of 264 patients between the ages of 18 and 89 underwent thyroid surgery during the study period (133 in phase A and 131 in phase B). Overall histopathological diagnoses were nodular goiter (54.9%), hyperplastic nodules (14.7%), adenoma (8.3%), thyroid cancer (18.2%), and Hashimoto thyroiditis (3.8%). Total thyroidectomy was performed in 91 patients in phase A versus 115 patients in phase B (P < 0.001), whereas the use of subtotal thyroidectomy and lobectomy decreased over time. A trend toward increased morbidity was noted in phase B. Seven patients had hypocalcemia in phase A, whereas 11 patients had hypocalcemia in phase B. Similarly, 5 patients had some degree of vocal cord paralysis in phase A, compared with 7 in phase B (P > 0.05). Morbidity was significantly increased in the case of cancer or reoperation. CONCLUSION: Despite the slightly higher risk of complication associated with total thyroidectomy, this has gradually replaced more conservative approaches for the treatment of both benign and malignant thyroid diseases. Reoperations and surgery for thyroid cancer carried a higher risk of complications.     

Antithyroid antibody dynamics in patients with Hashimoto's goiter receiving conservative treatment and after surgical interventions

The content of antithyroid antibodies (AtAb) in the blood of patients with Hashimoto's goiter was studied over time, namely during the treatment with thyroid drugs and after surgical interventions of different scope. The patients' groups with diverse changes in the AtAb titers during the conservative treatment were revealed. The analogous types of the time-course of changes in antibodies to thyroglobulins (AbTg) were discovered after a surgical intervention irrespective of the operation scope whereas the persistence of antibodies to microsomal antigen (AbMa) after the operation depended on the mass of the remaining thyroid tissue. A correlation was found between the high titers of AbTg (rather than AbMa) and the elevated content of thyrotropic hormone in untreated patients with Hashimoto's goiter and after large-scope surgical interventions.     

Section 2. Thyroid: Video-assisted neck surgery for thyroid and parathyroid diseases

Background: Endoscopic surgery has now become a well-established modality for the treatment of various organ diseases. In the present study, we analyzed the surgical results achieved by video-assisted neck surgery (VANS) in thyroid and parathyroid diseases. Methods: From January 2000 to April 2002, 87 patients (eight males and 79 females) with a mean age of 49 years underwent VANS. The preoperative diagnoses of these patients included 37 benign thyroid tumors, 30 Graves’ diseases, 17 parathyroid adenomas and three thyroid cancers. Results: The mean operative time of VANS was 165 min for a hemithyroidectomy, 287 min for a subtotal thyroidectomy, and 157 min for a parathyroidectomy. The mean intraoperative blood loss was 60, 183 and 23 g for a hemithyroidectomy, subtotal thyroidectomy and parathyroidectomy, respectively. No conversion from VANS to conventional surgery was experienced. Three patients (3.4%) had temporary palsy of the recurrent laryngeal nerve. Otherwise, the postoperative courses were uneventful. Conclusions: VANS for thyroid and parathyroid diseases was found to be safe and effective. From a cosmetic point of view, a high degree of patient satisfaction was obtained. VANS is thus considered to be an excellent option for selected patients with thyroid and parathyroid diseases.     

Minimally invasive endocrine surgery: aspects of diagnostic imaging

Since 1997 minimally invasive surgical techniques are used for the treatment of diseases of the adrenals, thyroid, parathyroid and the endocrine pancreas. In contrast to open surgical procedures special radiological examinations are the basis for minimally invasive techniques after biochemical testing. The basis of excellent results are a careful evaluation and preparation of the patient in a centre with experience in the open techniques and a frequency of at least 20 endoscopic adrenalectomies a year. Adrenal tumours can be removed endoscopically through a transperitoneal or an extraperitoneal route. The endoscopic exploration of the parathyroids in patients with biochemically proven primary hyperparathyroidism was modified to video-assisted exploration because of the long operating times. An alternative to the video-assisted procedure is the minimally invasive open exploration. With this technique reoperations can be performed and ipsilateral thyroid nodules (found in more than 50% in middle Europe) can be removed. Small solitary thyroid nodules are the indication for an endoscopic or video-assisted exploration of the thyroid. A laparoscopic exploration of the pancreas was performed in 68 patients with neuroendocrine pancreatic tumours. The experience of the surgical team improves the postoperative long term results, thus minimally invasive endocrine surgery should be performed in centres with great experience in the treatment of endocrine tumours and with the possibility of close contact to other specialists interested in this topic.