FOCUS超声刀在小切口甲状腺手术中的应用

目的 探讨应用FOCUS超声刀在小切口甲状腺手术中效果。方法 对我科于2008年7月－2009年9月,80例甲状腺良性疾病（IIo）采用颈部小切口及FOCUS超声刀下施行甲状腺手术进行回顾性分析。结果 手术平均时间45min（30～75min）,术中平均出血量15ml（5～30ml）,术后未出现大出血、声音嘶哑、口角麻木等并发症,术后24h平均切口引流量20ml（15～30ml）。术后平均住院时间3天（2～5天）。结论：FOCUS超声刀在甲状腺中应用能减少手术时间、术中出血,手术并发症少,术后恢复快,手术切口小,而且具有美容效果。     

超声刀在开放性小切口甲状腺切除术中的应用(附89例报道)

目的探讨超声刀在开放性小切口甲状腺手术中的应甩效瀑。方法总结我科于2004年4月至2007年12月期间对89例甲状腺良性疾病患者开展的开放性小切口（3～4cm）甲状腺切除术，手术中采用超声刀代替传统的结扎和缝扎方法对甲状腺血管和腺体进行处理。结果手术平均时间70（40～135）min，术中平均出血量15（5～20）ml，术后24h平均切口引流量25（10～50）ml。无出血、神经、甲状旁腺损伤及其他并发症。切口Ⅰ类／甲级愈合．术后平均住院时间5（3～6）d。结论超声刀应用于开放性小切口甲状腺切除，可以方便手术操作。提高手术效率，止血效果可靠，有特有的实用价值。     

改良Miccoli术式内镜下甲状腺手术667例分析

目的 探讨腔镜辅助下颈部小切口甲状腺手术（Miccoli 术式）中的技巧,总结手术各项指标及相关经验。方法 回顾性分析2006年6月至2010年4月吉林大学第一医院甲状腺外科667例腔镜辅助下颈部小切口行甲状腺手术的临床资料。 结果 667例均顺利完成腔镜辅助甲状腺手术。前50例手术平均时间（60±13）min;后617例平均（39±9）min。术中出血量15～80mL,术后引流量5～35mL,均于第2天拔除引流管。术后住院时间（3±1）d。手术切口长2.0～2.5cm。术后均未使用止痛药, 出现暂时性声嘶1例,皮下气肿1例,中转开放手术10例。所有病例均未发生术后出血或感染。全组随访3~12个月,无一例复发。结论 腔镜辅助下颈部小切口甲状腺手术安全可靠、并发症少且美容效果相对较好,在掌握一定技巧的基础上实施,临床效果更佳,应用前景广阔。     

232例低领小切口甲状腺切除术的疗效分析

目的探讨采用低领小切口甲状腺切除术的应用可行性。方法回顾性分析2003-01—2011-08 232例采用低领小切口甲状腺切除术治疗甲状腺结节患者的临床资料。结果所有患者均手术成功,手术时间38～96 min,平均52 min,术中出血量10～90 mL,平均30 mL;随访6～36月,无复发病例。结论低领小切口甲状腺切除术创伤小,并发症少、操作简单、效果好,值得广大基层医院临床推广。     

超声刀在小切口甲状腺腺叶切除术中的应用

目的探讨超声刀在小切口甲状腺腺叶切除术中的应用。方法回顾分析泉州医学高等专科学校附属人民医院56例采用超声刀小切口行甲状腺腺叶切除术的临床资料,对超声刀在小切口的疗效进行分析。结果 56例手术顺利,术中平均出血量20mL,平均手术时间为54min。患者术后均未出现声音嘶哑及继发出血或血肿等并发症。切口均一期愈合,术后平均住院时间4.6天。结论应用超声刀小切口切除甲状腺叶具有出血少、恢复快、并发症少的优点,值得临床推广。     

高龄粗隆间骨折的微创治疗应用探讨

目的 探讨小切口微创技术治疗高龄股骨粗隆间骨折的方法及其疗效。方法 收集近2年来65岁以上高龄粗隆间骨折病例33例，其中小切口DHS治疗18例，微创Gamma钉治疗15例，对手术切口大小、操作时间、术中术后出血量、并发症、术后髋关节功能评定进行临床随访分析。结果 33例均得到随访，小切口DHS组：切口长度为4cm（3～5cm），平均手术时间70min（60～100min），平均出血100mL（50～200mL）；微创Gamma钉：切口长度为3cm（2．5～4．5cm），平均手术时间50min（40～70min），平均出血65mL（30～100mL）。对两组进行术后功能评定，优30例（90．9％），良3例（9．1％）。结论 小切口技术治疗股骨粗隆骨折创伤小，是高龄患者一种理想的治疗方法。     

LigaSure血管闭合系统在腹腔镜肾切除手术中的应用

目的 探讨LigaSure血管闭合系统在腹腔镜肾切除术中的应用价值. 方法 2004年5月至2006年12月应用LigaSure完成41例腹腔镜下单纯肾切除术、腹腔镜根治性肾切除术及腹腔镜肾输尿管全长切除术.观察手术时间、术中出血量、是否中转开放、术后引流时间、术后引流量、术后住院时间以及并发症等情况. 结果 41例手术均获成功,无中转开放手术及严重并发症.手术时间35～240 min,平均146 min;术中出血量30～450 ml,平均163 ml;术后引流1～6 d,平均3 d;术后总引流量45～435 ml,平均229 ml;术后住院时间6～21 d,平均10 d. 结论 腹腔镜下手术中LigaSure能安全高效地闭合血管及组织束,显著减少手术时间和术中出血,缩短术后住院天数,是一种有效的血管控制系统,在腹腔镜下肾切除术中具有良好的应用前景.     

甲状腺瘤改良小切口术的临床观察

目的：探讨甲状腺瘤改良小切口术的临床疗效及优点。 方法：选择2009年3月—2011年2月住院治疗的甲状腺瘤患者128例，随机分为治疗组和对照组各64例，治疗组采用甲状腺瘤改良小切口术手术治疗，对照组采用传统的甲状腺瘤手术治疗，观察比较临床疗效及优点。 结果：两组手术时间﹑切口大小﹑术中出血量﹑平均住院时间﹑术后并发症及满意度治疗组明显优于对照组（P<0.05）。 结论：甲状腺瘤改良小切口术能减少手术创伤及术中出血量，缩短手术时间﹑平均住院时间，提高疗效和满意度，甲状腺瘤改良小切口术疗效明显，值得在临床上推广应用。     

应用超声刀行小切口甲状腺开放手术146例

目的探讨应用超声刀行小切口甲状腺开放手术的方法及可行性。方法 2008年3月至2010年2月,146例甲状腺良性肿瘤患者行小切口甲状腺开放手术。结果所有手术均成功,切口长度为2～4 cm,手术时间65～120 min,术中出血量5～68 ml,术后未出现手术并发症。结论应用超声刀行小切口甲状腺开放手术具有良好的美容效果,并且可以明显减少术中出血量、缩短手术时间及降低术后并发症的发生率,增加手术安全性,缩短腔镜甲状腺手术的学习曲线。     

后腹腔镜联合腹部小切口根治性肾输尿管切除术治疗肾盂癌的临床研究

目的：探讨后腹腔镜联合腹部小切口根治性肾输尿管切除术治疗肾盂癌的临床应用价值。方法：回顾性分析2002年1月～2007年12月施行的61例后腹腔镜联合腹部小切口根治性肾输尿管切除术（腔镜组）及47例开放性根治性肾输尿管切除术（开放组）的临床资料，比较两组手术时间、术中出血量、术后肠功能恢复时间、局部复发、切口种植转移等指标。结果：腔镜组平均手术时间120（90～150）min，平均术中出血量60（20～450）ml，平均术后肠功能恢复时间1．5（1～2）天，术后切口感染3例，切口侧下腹部皮肤感觉过敏者5例，无严重并发症出现。开放组平均手术时间150（120～200）min，平均术中出血量150（100～500）ml，平均术后肠功能恢复时间2（1．5～3）天，术后切口感染6例，切口侧下腹部皮肤感觉过敏者15例，无严重并发症出现。腔镜组手术时间、术中出血量、术后肠功能恢复时间明显优于开放组（P〈0．01）。结论：后腹腔镜联合腹部小切口根治性肾输尿管切除较开放性手术治疗肾盂癌具有微创、安全、可靠等特点；无局部重要脏器及大血管浸润和粘连的肾盂癌均适合行后腹腔镜手术切除术。     

钳式LigaSure和钳式超声刀在开放性甲状腺全切除术中的应用比较研究

目的比较钳式LigaSure（LSJI）和钳式超声刀（FOCUS）在开放性甲状腺全切除术中的临床应用效果。 方法回顾性分析中山大学孙逸仙纪念医院甲状腺外科2013年6月至10月行开放性甲状腺全切除术的189例患者资料,按照术中使用的辅助工具分为FOCUS辅助下手术组（F组）及LSJI辅助下手术组（L组）,比较两组患者的病史特点、切除甲状腺时间、术中、术后出血量及术后并发症的发生率。 结果L组切除甲状腺平均时间为（35.3±8.6）min,F组为（48.5±9.1）min。切除甲状腺时间长短与术中使用的辅助工具相关,两者之间的差异有统计学意义（P<0.05）;而两组患者的术中、术后出血量、术后血肿发生率、甲状旁腺功能减退发生率、喉返神经损伤性声嘶发生率等差异无统计学意义。 结论LSJI和FOCUS作为甲状腺全切除术的辅助工具均是安全、有效的,但LSJI有助于更高效完成手术。     

Use of a diathermy system in thyroid surgery

HYPOTHESIS: New hemostatic methods have been widely used in open and laparoscopic surgery. The LigaSure Precise diathermy system (Valleylab, Boulder, Colo) has been recently used in thyroid surgery. We hypothesized that its use could lead to reduced operative time and fewer complications compared with conventional knot tying in total or near-total thyroidectomy. DESIGN: Prospective case-controlled study. SETTING: Tertiary care private hospital. PATIENTS: Eighty patients underwent total or near-total thyroidectomy by 1 surgeon. INTERVENTIONS: Forty patients underwent thyroidectomy with the conventional knot tying technique and 40 patients with the LigaSure diathermy system. MAIN OUTCOME MEASURES: Demographics, histopathological diagnosis, operative time, intraoperative blood loss, complications, and cost, using chi2 test and Wilcoxon rank sum test. RESULTS: The study groups had similar demographic and histopathological characteristics. The mean +/- SD operative time was nonsignificantly reduced in the LigaSure group compared with the conventional knot tying group (84 +/- 6 vs 89 +/- 7 minutes, P = .60). The mean +/- SD intraoperative blood loss was less for the LigaSure group (30 +/- 5 vs 35 +/- 8 mL, P = .36). There was 1 case of transient recurrent laryngeal nerve palsy in the LigaSure group. One patient from this group and 2 patients from the other group exhibited transient hypocalcemia; permanent postoperative hypocalcemia was not encountered in either group. The cost of the LigaSure diathermy system was significantly greater than that of conventional knot tying. CONCLUSION: Use of the LigaSure in thyroid surgery did not significantly reduce operative time, blood loss, or complication rates compared with conventional knot tying, but it increased operative cost.     

Use of BiClamp Decreased the Severity of Hypocalcemia after Total Thyroidectomy Compared with LigaSure: A Prospective Study

BACKGROUND: Postoperative hypocalcemia is the most common complication after thyroidectomy. New surgical devices have been propose to achieve vessel sealing and hemostasis. However, the risk of parathyroid glands damage has not been fully elucidated. This prospective study was designed to evaluate the severity of hypocalcemia after total thyroidectomy by using two different sealing devices. METHODS: Between January 2005 and December 2006, 86 patients underwent total thyroidectomy by using BiClamp((R)) (n = 46) or LigaSure((R)) (n = 40) devices in our institution. The severity of postoperative hypocalcemia was analyzed. RESULTS: No mortality or recurrent laryngeal nerve palsy was observed. Patients characteristics were similar in both groups. The mean operation time was significantly shorter in the BiClamp group (142 +/- 35 minutes versus 170 +/- 57 minutes, P = 0.023). Eleven patients had symptomatic hypocalcemia. Hypocalcemia (< 2 mmol/l) at postoperative day 1 was more frequent in the LigaSure group than in the BiClamp group (P = 0.034). Significantly more patients in the LigaSure group required oral calcium supplementation than in the BiClamp group (67.5% versus 34.7% respectively; P = 0.002). CONCLUSION: The present prospective study suggests that total thyroidectomy can be performed safely with both surgical devices. However, BiClamp reduced the operative time and the severity of postoperative hypocalcemia.     

LigaSure versus clamp-and-tie thyroidectomy for benign nodular disease

BACKGROUND: LigaSure is an alternative bipolar diathermy system (BDS) combining vessel sealing with reduced thermal spread, which has been successfully used in many abdominal operations; however, there is a little experience in open thyroidectomy. This study compares the efficacy and the advantages of the LigaSure BDS when used for total thyroidectomy for benign thyroid disease with the conventional clamp-and-tie technique. METHODS: Between May 1998 and October 2002, 517 patients underwent total thyroidectomy for benign thyroid multinodular goiter. Among them, from May 1998 until May 2000, 247 patients (group I) were operated on with the conventional clamp-and-tie technique, whereas from May 2000 until October 2003, 270 patients (group II) underwent total thyroidectomy for benign multinodular goiter with LigaSure BDS through a 4-cm transverse suprasternal incision. Demographics, pathologic characteristics, gland mass, operative time, blood loss, and complications were assessed. RESULTS: There were no intraoperative complications. Thyroid mass was similar in both groups, but the operative time was shorter in group II than in group I (mean +/- standard deviation, 71 +/- 14 minutes vs 86 +/- 22 minutes; p < .01). Intraoperative total blood loss was similar between the two groups, but postoperative drain volume was less in group II than in group I (21 +/- 15 mL; p < .01). Major post-thyroidectomy complications (ie, laryngeal nerve palsy, hematoma, and hypocalcemia) occurred less frequently in the LigaSure group than in the clamp-and-tie group (0.7%, 0.4%, 1.1% vs 4%, 2%, 4.8%, respectively; p < .05). The mean +/- standard deviation postoperative hospital stay was significantly less for the patients in group II than for those in group I (2.3 +/- 1.7 days vs 2.8 +/- 1.3 days; p < .05). CONCLUSIONS: The use of the LigaSure vessel sealer for thyroid surgery is an effective and safe alternative that reduces the overall operative time and could be successfully applied through a narrow surgical incision.     

LigaSure和超声刀在Miccoli手术中的应用研究

目的 比较LigaSure血管闭合系统与超声刀在Miccoli手术中应用的手术时间和并发症.方法 回顾性分析上海交通大学附属第六人民医院普外科2007年1月至2011年12月期间684例行Miccoli术式患者的临床资料,其中应用LigaSure血管闭合系统者335例,应用超声刀完成手术者349例.对其平均手术时间及术后常见并发症(切口内血肿、一过性声音嘶哑、永久性喉返神经麻痹及低钙血症)进行对比.结果 所有684例患者中,有263例行甲状腺全切除术,421例行甲状腺腺叶切除术.使用超声刀者手术时间略短于使用LigaSure血管闭合系统,但二者比较差异无统计学意义(P＞0.05);二者的术后常见并发症比较差异亦无统计学意义(P＞0.05).结论 LigaSure血管闭合系统和超声刀设备应用于甲状腺手术均是安全、可靠的,术者可根据手术习惯及医院配备选择应用手术器械.     

Safely increasing the efficiency of thyroidectomy using a new bipolar electrosealing device (LigaSure) versus conventional clamp-and-tie technique

Operative time in thyroid surgery can be safely reduced through use of a new bipolar electrosealing device (LigaSure). We evaluated consecutive patients undergoing thyroid surgery from January 2003 through January 2005 (n=155). During the first half of the study, hemostasis was obtained using silk ties (conventional group, n=70). During the second half of the study period, hemostasis was obtained with a bipolar electrosealing device (LigaSure group, n=85). The mean operative time was 130 +/- 37 minutes in the conventional group and 110 +/- 33 minutes (P < 0.001) in the LigaSure group. EBL in the LigaSure group was statistically significantly less (43 +/- 53 vs 33 +/- 33 mL; P < 0.05). Postoperative calcium level was statistically significantly higher in the LigaSure group (8.2 +/- 0.5 vs 8.4 +/- 0.6 mg/dL, P < 0.05). Hospital length of stay (LOS) did not differ significantly. One patient in each group developed neck hematoma requiring reoperation. One permanent recurrent nerve injury occurred in the conventional group and one transient bilateral recurrent nerve injury occurred in the LigaSure group. The occurrence of symptomatic hypocalcemia was similar between the two groups. The training level of the surgical resident had no significant impact on the operative time, estimated blood loss (EBL), LOS, or complication rate. LigaSure bipolar electrosealer as the primary means of hemostasis during thyroidectomy significantly reduces mean operative times. Rates of operative complications were unchanged. LigaSure use in thyroid surgery can safely increase efficiency.     

LigaSure vs clamp-and-tie technique to achieve hemostasis in total thyroidectomy for benign multinodular goiter: a prospective randomized study

HYPOTHESIS: Occurrence of adverse effects and advantages of the LigaSure diathermy system (or LigaSure vessel sealing system) in total thyroidectomy have not been tested in prospective randomized studies comparing its use with that of the time-saving clamp-and-tie technique to ligate and divide thyroid vessels. The effectiveness of LigaSure in achieving vessel division and hemostasis remains dependent on vessel diameter, and the risk of damage to adjacent structures cannot be completely excluded. We tested the hypothesis that use of LigaSure compared with the clamp-and-tie technique can significantly and conveniently reduce operative time without increasing postoperative complications in patients undergoing total thyroidectomy for benign multinodular goiter. DESIGN: Prospective randomized study. SETTING: Regional hospital. PATIENTS: Two hundred consecutive patients with benign multinodular goiter undergoing total thyroidectomy performed by 1 of 3 surgeons. INTERVENTIONS: According to a randomized sequence, total thyroidectomy was performed in 100 patients using LigaSure and in 100 patients using the clamp-and-tie technique. MAIN OUTCOME MEASURES: End points of the study included the comparative evaluation of postoperative complications, need for parathyroid gland autotransplantation, operative time, and time to hospital discharge. Preoperative, postoperative (24 hours), and 6-week follow-up serum Ca(++) levels are also reported and compared. RESULTS: The postoperative complication rate was 35% overall, including all transient postoperative disturbances. The incidence of cervical hematomas was 2%, but 3 patients (1.5%), 1 in the LigaSure group and 2 in the clamp-and-tie group, required repeat operations because of respiratory tract obstruction. The incidence of permanent complications was 2.5% overall, including 3 patients (1.5%) with permanent hypocalcemia and 2 patients (1%) with permanent recurrent nerve lesions. No statistical difference in the incidence of complications was found between the 2 study groups. Similarly, no difference was found in mean hospitalization time and need for parathyroid gland autotransplantation. Preoperative, postoperative, and 6-week follow-up mean serum Ca(++) levels were not statistically different in the 2 study groups and in the subset of patients undergoing parathyroid gland autotransplantation. Mean operative time was significantly shorter in the LigaSure group, although the mean difference between the 2 study groups was minimal (7.4 minutes). Concomitantly, there was an additional cost of 45euro (US $57.40) per operation using LigaSure. CONCLUSION: The use of LigaSure is equally as safe and effective at vessel division and homeostasis as the clamp-and-tie technique, with a statistically significant (although minimal) decrease in mean operative time. Because of this minimal decrease in operative time, use of LigaSure would allow more patients to undergo total thyroidectomy each year, which would eventually help to offset its higher cost.     

LigaSure血管闭合系统在腹腔镜脾功能亢进脾切除术中的应用(附28例报告)

目的:探讨LigaSure闭合系统在脾功能亢进患者行腹腔镜脾切除术中的应用价值。方法:为28例脾功能亢进患者施行完全腹腔镜脾切除术。应用LigaSure离断脾周韧带及部分脾蒂血管。结果:28例手术均获成功。手术时间55～210min,平均120min。术中出血30～220ml,平均115ml(不包括脾血)。22例术后少量腹水。术后12～24h恢复胃肠蠕动,术后24h拔除胃管并进流质饮食,术后住院5～9d,平均6.5d。结论:LigaSure可安全、有效地闭合脾周韧带和大部分血管,减少了术中出血,降低了手术风险。     

Thyroidectomy with LigaSure versus traditional thyroidectomy: our experience

Over the past few decades the surgical strategy for both benign and malignant thyroid diseases has undergone several changes. In particular, total thyroidectomy today has become the routine operation for most thyroid diseases. The complications of this surgical procedure, though of multifactorial aetiopathogenesis, are often related to the efficacy of the haemostasis. Our aim in this study was to verify whether the use of the new LigaSure haemostatic system is capable of reducing the incidence of these complications as well as operative times and length of hospital stay as compared to the conventional haemostatic procedures. Twenty-five patients were randomly assigned to thyroidectomy with LigaSureTM (group A), and 25 to total thyroidectomy using the conventional haemostasis procedures (group B). Of these, 39 were women and 11 men, with a mean age +/- standard deviation of 52.26 +/- 13.57 years. In both groups the thyroidectomy was performed according to the standard total thyroidectomy surgical technique entailing the placement of two aspiration drainages at the end of the operation. As regards the assessment of operative times, these were significantly lower in thyroidectomy with LigaSureTM compared to traditional thyroidectomy (duration: 60 +/- 14.8 min [range: 60-105) in group A versus 92.4 +/- 27.5 min [range: 70-150] in group B, p = 0.02). The total amount of fluid drained postoperatively was substantially similar in the two groups (145 +/- 80 cc in group A versus 140 +/- 64.1 cc in group B). The incidence of postoperative complications was also similar in the two groups. We had only one case of haemorrhage in a patient submitted to thyroidectomy with LigaSureTM, 8 cases of transitory hypocalcaemia, 3 of which in patients with LigaSure thyroidectomy and 5 in patients treated with traditional thyroidectomy (p = 0.42), 2 cases of stupor of the recurrent nerve (1 in group A and 1 in group B) and a single definitive recurrent lesion in a group B patient with carcinoma, in which the tumour infiltrated the recurrent nerve. We observed no cases of definitive hypocalcaemia. The mean postoperative hospital stay of the patients in group A was 1.88 +/- 0.44 days as against 2.2 +/- 0.41 days in group B. The statistical analysis revealed a significant difference between the two groups (p = 0.01).     

Use of the electrothermal vessel sealing system versus standard vessel ligation in thyroidectomy

OBJECTIVE: The electrothermal vessel sealing system (LigaSure) facilitates operative haemostasis by fusing blood vessel walls to form a collagen seal. The LigaSure is currently used in a variety of gastrointestinal, gynaecological and urological operations. We report our experience with LigaSure for thyroidectomy to test the hypothesis that it reduces operating time without increasing complications compared with standard vessel ligation. METHODS: This non-randomized, retrospective review included 234 consecutive patients who underwent thyroidectomy by one surgeon. Standard vessel ligation was used in 99 patients between 1997 and 2000, and the LigaSure was used in 135 patients between 2001 and 2003. The following data were collected: patient demographics, thyroid pathology, type of operation (total thyroidectomy vs lobectomy), operating time, complications (transient or permanent hypocalcaemia, 相似文献