FOCUS超声刀在开放性甲状腺手术中的应用

目的探讨FOCUS超声刀在开放性甲状腺手术中的应用价值。方法行单侧甲状腺次全切除术的患者180例,其中82例采用FOCUS超声刀(超声刀组)手术,98例采用常规电刀(常规组)手术。比较两组手术切口大小、术中出血量、手术时间、术后引流量、手术早期并发症、术后24 h VAS及术后住院时间。结果超声刀组手术时间为(57.18±7.28)min、术中出血量为(20.26±10.78)mL、术后引流量为(22.13±11.02)mL、术后24 h VAS为(3.53±0.65)分、术后住院时间为(5.19±0.74)d,常规组分别为(79.03±12.73)min、(63.76±31.91)mL、(59.07±29.15)mL、(5.13±0.82)分、(5.48±0.90)d,两组比较,P均<0.05。超声刀组无术后出血患者,术后声音改变2例,常规组分别为1、2例(P均>0.05)。结论 FOCUS超声刀操作灵活、方便,应用于开放性甲状腺手术可减少术中出血量、缩短手术时间、减少手术创伤。     

FOCUS超声刀在老年甲状腺手术治疗中的应用

目的探讨FOCUS超声刀在老年甲状腺手术中的临床疗效和安全性。 方法选取2014年1月至2017年6月山东滨州医学院烟台附属医院收治的87例老年甲状腺手术患者,其中采用FOCUS超声刀治疗42例（超声刀组）,采用电刀治疗45例（电刀组）,比较两组患者手术时间、住院时间、切口长度、术中出血量、术后引流量等手术情况,以及术后感染、术后出血、一过性声音嘶哑、永久性声音嘶哑、暂时性低钙血症、永久性低钙血症等并发症的发生情况。两组间的比较采用t检验。 结果与电刀组相比,超声刀组手术时间、住院时间均显著短于电刀组（t=14.283、27.021,均P<0.01）,切口长度、术中出血量、术后引流量均显著少于电刀组（t=19.427、10.298、25.034,均P<0.01）。超声刀组术后并发症发生率显著低于电刀组,差异有统计学意义（4.76%、15.56%,P<0.01）。 结论FOCUS超声刀在老年甲状腺手术中具有比电刀更好的临床疗效和安全性,值得临床推广应用。     

甲状腺手术中超声刀的应用及对术后血钙的影响

目的 探讨甲状腺手术中超声刀的应用对术后血钙的影响.方法 对我科2008年1月～2011年1月525例甲状腺切除手术患者进行回顾性研究.结果 525例甲状腺切除手术病例,术后发生低钙血症21例,发生率4.00％,其中超声刀组16例、发生率为6.99％,非超声刀组5例、发生率为1.69％,超声刀组较非超声刀组发生率增加(P＜0.05).结论 甲状腺手术中超声刀的应用影响了甲状旁腺的血运及功能,从而导致术后低钙血症的发生增加.     

超声刀在腹腔镜阑尾切除术中的临床应用

超声刀作为一种新型的手术器械,正逐渐应用于临床外科。我院自2000年6月以来,应用超晰迅声止血刀进行腹腔镜阑尾切除术46例,均获得了令人满意的临床效果。现报告如下。 1.临床资料:本组阑尾炎患者共46例,男26例,女20     

无张力被膜解剖法在甲状腺手术中的应用效果观察

目的 观察无张力被膜解剖法在甲状腺手术中的应用效果.方法 选取需行甲状腺全切除术及次全切除术患者各40例,将其随机分为观察组和对照组,各40例.观察组采用无张力被膜解剖法进行手术,对照组采用常规手术方法进行手术.比较两组患者术前及术后第2、7、14天血钙、甲状旁腺激素(PTH)水平.结果 术后第2、7、14天观察组行甲状腺全切除术、次全切除术者血钙、PTH水平均高于对照组,P均＜0.05.结论 与常规手术方法比较,采用无张力被膜解剖法进行甲状腺全切除术、次全切除术,术后血钙、PTH水平较高.     

甲状腺手术前后甲状旁腺激素的变化

甲状腺手术前后甲状旁腺激素的变化毕亚，纪连福我科对１０例行甲状腺次全切除术患者进行手术前、后血中用状旁腺激素（ＰＴＨ）含量及血钙、血磷值测定，探讨甲状腺手术前后甲状旁腺功能的变化。一、病例：结节性甲状腺肿７例，甲状腺瘤３例，均经病理证实。二、方法：１...     

老年人腹腔镜下超声刀胆囊切除术后对肝功能的影响

腹腔镜下胆囊切除(LC)已占胆囊切除术的80％～90％,应用电刀电凝电切可使肝脏部分组织热电损伤变性发白和电凝固性坏死焦痂形成,并致肝转氨酶一过性升高。我们拟探讨在腹腔镜下应用超声刀切除老年人胆囊对肝功能的影响,报道如下。 一、对象和方法 1.对象:2000年8～9月我院收治的56例老年结石性胆囊炎患者,男24例,女32例,年龄60～88岁,平均67     

双极电凝镊与超声刀对甲状旁腺的保护作用

目的 探讨双极电凝镊与超声刀在甲状腺癌全甲状腺切除术中对甲状旁腺的保护作用.方法 回顾性分析2017年6月至2019年6月在锦州医科大学附属第一医院因甲状腺癌行甲状腺全切除患者304例,分为实验组与对照组,实验组对旁腺游离使用双极电凝镊,对照组使用超声刀.观察术前及术后第3、7、30天甲状旁腺素值(PTH)和血钙值、术...     

超声刀在腹腔镜阑尾切除术中的应用体会

随着腹腔镜手术的广泛开展,新能源不断出现并应用于临床。传统的腹腔镜手术中常见操作如分离、切割、止血等都是用高频电刀来完成,自１９９１年超声刀首次应用于外科手术并获得成功,并在其后广泛应用于腹腔镜手术,在操作中增添了一种创伤小止血效果确切的仪器。我们总结了３０例超声刀在腹腔镜阑尾切除术中的应用。现报告如下。１．一般资料：本组３０例中男性１５例,女性１５例;年龄１３～４２岁,平均２５．９岁。其中包括急性阑尾炎１４例发病时间８～３６ｈ均有转移性右下腹疼痛和恶心、呕吐等消化道症状,实验室检查血白细胞升高…     

超声刀联合弧形切割吻合器在低位直肠癌超低前切除术中的应用

目的: 探讨超声刀联合弧形切割吻合器在低位直肠癌超低前切除术中的应用效果.方法: 回顾性分析我院2005-07/2009-02收治的行直肠癌超低前切除术32例的临床资料. 其中, 采用超声刀联合弧形切割吻合器12例, 采用电刀联合线形吻合器20例. 观察2组患者的手术成功率、手术时间、术中出血量、术后前3 d引流量、术后恢复时间以及术后并发症的差异.结果: 超声刀联合弧形切割吻合器组较电刀联合线形吻合器组手术成功率显著提高( P<0.05), 而手术时间( U = 12.5, W = 90.5,P<0.05)、术中出血量( t = -4.968, P<0.05)、术后前3 d引流量( t = -6.507, P<0.05)、引流时间( t = -3.888, P<0.05)和恢复时间( U = 27.0, W =105.0, P<0.05)方面均显著减少.结论: 超声刀联合弧形切割吻合器在直肠癌超低前切除术中应用效果显著.     

Simple harmonic scalpel hemorrhoidectomy utilizing local anesthesia combined with intravenous sedation: a safe and rapid alternative to conventional hemorrhoidectomy.

Background

Harmonic Scalpel® hemorrhoidectomy (HSH) is an established surgical therapy for the treatment of symptomatic grade III and IV hemorrhoids. Hemorrhoid surgery is still being performed as an inpatient procedure with general or regional anesthesia in many centers today. There was a trend toward performing hemorrhoid surgery as an ambulatory procedure using local anesthesia supplemented with intravenous sedation. The aim of the current study was to evaluate the safety and efficacy of HSH performed with combination local anesthesia and intravenous sedation in an ambulatory surgical center.

Materials and methods

A retrospective review was performed on the clinical charts of all patients undergoing HSH in an ambulatory surgical center from 2001 to 2005. All hemorrhoidectomies were attempted under propofol/ketamine intravenous sedation and local anesthesia in the prone position. A simple, open technique without routine suture was used.

Results

During the study period, 180 patients (70 females) underwent HSM. Mean procedure and total operating room time were 12 and 28 min, respectively. One patient (0.6%) was converted to general endotracheal anesthesia. Ten patients (5.6%) required post anesthesia care unit (PACU) observation. All patients were discharged home after the procedure. Postoperative complications occurred in 19 patients (10.6%). There were no reoperations and the total readmission rate was 3.7%.

Conclusion

HSH performed with a combination of intravenous sedation and local anesthesia is safe and effective in the ambulatory surgery setting. The combined technique was associated with a rate of complications comparable to published series utilizing conventional hemorrhoidectomy techniques. Added benefits include shorter hospital stay and a potential for cost savings.     

Video-assisted thoracoscopic left upper lobe apical trisegmentectomy with the Harmonic scalpel

Segmental resection is a useful procedure to preserve respiratory function. A 56-year-old woman presented with a finding of a left upper lobe lesion on CT scanning. She was performed video-assisted thoracoscopic left upper lobe apical trisegmentectomy with the Harmonic scalpel. Video-assisted thoracoscopy surgery (VATS) segmentectomy is associated with safe and feasible procedure. With the Harmonic scalpel dissection, blood loss is minimal and this speeds patient recovery.     

Harmonic scalpel hemorrhoidectomy: preliminary results of a new alternative method

Surgical treatment is considered to be the best therapeutic modality for severe hemorrhoidal disease. Different surgical methods of hemorrhoidectomy aim to decrease pain, bleeding, stenosis and discharge. The aim of this study was to evaluate the efficacy of harmonic scalpel hemorrhoidectomy. During a period of seven months, 54 consecutive patients with third- and fourth-degree hemorrhods were prospectively randomized for harmonic scalpel hemorrhoidectomy (HS) or Milligan-Morgan procedure (MM). These patients were examined at one, two, and six weeks after the operation. All patients had a lower gastrointestinal investigation prior to operation to exclude other colorectal pathologies. All patients had the same kind of preoperative preparation and analgesia during the postoperative course. Pain was assessed using a visual analog scale from 0 to 10. Patient satisfaction was defined as decrease or absence of symptoms and return to normal daily activities. HS groups included 29 patients, while the MM group had 25 patients. There as no difference between the groups in terms of age, gender, hemorrhoidal degree and indication for operation. The types of intra-operative anesthesia administered to the two groups were similar. Duration of surgery was significantly higher in the MM group (p<0.0001). Postoperative hospitalization was longer in the MM group (p<0.0001), and the pain degree was higher in MM group (p<0.0001). No significant difference was noted in the overall amount of analgesics used in the two groups at week 1, although it was significantly higher in the MM group 2 and 3 weeks after the operation. Early complication occurred more frequently in the MM group but overall the difference was not statistically significant. In conclusion, harmonic scalpel hemorrhoidectomy is virtually a bloodless operation with minimal tissue damage. It is associated with significant less postoperative pain and a fast return to normal activity. Received: 11 February 2002 / Accepted: 12 June 2002 Correspondence to Z. Dreznik     

经胸入路腔镜下甲状腺肿块切除术的探讨

目的 探讨腔镜下甲状腺切除的方法与优缺点。方法选择10例甲状腺肿块病人施行经胸入路腔镜下甲状腺肿块切除术。结果全部病例手术均获成功，平均手术时间145min，平均住院天数6d，无喉返神经、甲状旁腺损伤及其它并发症。结论经胸入路腔镜下甲状腺切除术是安全可行的，具有很好的美观效果。     

医用纤维蛋白胶在甲状腺手术中的应用

目的探讨医用纤维蛋白胶在甲状腺手术中的应用价值。方法将79例甲状腺手术患者随机分成实验组（44例）和对照组（35例）。实验组行甲状腺切除术，同时在手术创面喷洒医用纤维蛋白胶5ml，对照组行甲状腺切除术，术中不用医用纤维蛋白胶，两组均放置引流管。观察两组术后总引流量、第1天引流量、拔管时间、伤口感染和拆线时间等情况。结果实验组术后皮下总引流量、第1天引流量和拔管时间均少于对照组（P〈0．05）。两组间伤VI感染发生率、拆线时间无明显差别（P〉0．05）。结论应用医用纤维蛋白胶可有效地减少甲状腺术后创面渗液，促进创面愈合。     

Ultrasonically activated scalpel is an effective tool for cutting the pancreas in biliary-pancreatic surgery: experimental and clinical studies

The ultrasonically activated scalpel, a new tool for cutting and coagulating tissue, uses high‐frequency ultrasonic vibrations, and has been widely employed in the field of laparoscopic surgery. We evaluated its usefulness for cutting the pancreas in biliary‐pancreatic surgery. We planned experimental and clinical studies using an ultrasonically activated scalpel (harmonic scalpel) for cutting the pancreas. The harmonic scalpel was set up at a power level of 3 (75% of full power) in the knife mode. In the experimental study, using dogs, cutting of the pancreas with the harmonic scalpel resulted in significantly less bleeding and significantly less histologicall tissue damage to the cut stumps than cutting of the pancreas with an electric or a regular scalpel. In the clinical study: (1) the hemostatic effect of the harmonic scalpel was excellent or good in any condition of the pancreas; (2) of 50 stumps of the main pancreatic duct cut with the harmonic scalpel, the stump was easily found in 48 (96%), while ultrasonography was necessary to find the remaining 2 stumps in soft pancreas; (3) in 41 anastomoses (29 soft and 12 hard pancreas) there were no postoperative pancreatic fistulae. These results indicate that the ultrasonically activated scalpel is an effective tool for cutting the pancreas in biliary‐pancreatic surgery.     

Initial experience with the harmonic scalpel in liver surgery

BACKGROUND/AIMS: Hepatectomies are generally performed using a crushing clamp or by finger fracture. New instruments such as ultrasonic aspirators or water jet dissectors are increasingly used for precise dissection of intrahepatic structures. An ultrasonically activated scalpel has been introduced, mainly for laparoscopic procedures. The potential of this instrument in liver surgery remains to be defined. METHODOLOGY: In a prospective study, we have tested the harmonic scalpel (Ultracision, Ethicon Endo-surgery) in 16 consecutive patients undergoing liver surgery. The ease of parenchymal dissection and the hemostatic effect of the ultrasonically vibrating blade was assessed in each operation. Blood loss and transfusions were recorded. RESULTS: One patient underwent excision of a liver cyst and 15 patients 16 hepatectomies for colorectal metastases (7 cases), hepatocarcinoma (5 cases) and other benign or malignant conditions (4 cases). The liver was cirrhotic in 4 cases. The performance of the harmonic scalpel for dissection, cutting and hemostasis was good or excellent in 16 operations, and poor in 1 hepatectomy in a cirrhotic liver. Median blood loss was 400 mL (range: 0-1200 mL) and 4 patients received blood transfusions. CONCLUSIONS: The harmonic scalpel allows efficient section of liver parenchyma, precise dissection of intrahepatic structures, good hemostasis and section of small intrahepatic vessels.     

Parenchymal transection with ultrasonic scalpel in liver resection

BackgroundThere is no ideal tool for parenchymal transection in liver resection and bleeding is still a major complication. The purpose of this study was to evaluate the usefulness of an ultrasonic scalpel and to describe our clinical experience in open liver resection.MethodsAn ultrasonic scalpel was used in seven consecutive patients undergoing liver resection. During parenchymal transection coagulation shears were used with the power level set at 2 or 3, and the blunt blades were selected.ResultsIn each case, bleeding from the liver parenchyma was trivial, but haemostasis of large vessels required suture ligation. Postoperatively none of the patients experienced local technical complications such as haematoma, bile leak or infection.DiscussionAlthough complete haemostasis of large vessels cannot be achieved, the ultrasonic scalpel may be used for parenchymal transection in liver resection to reduce blood loss. Larger series of patients are needed before a definitive statement regarding the efficacy of this method can be made.     

Influence of intravenous anesthetics on neuromonitoring of the recurrent laryngeal nerve during thyroid surgery

Limited reports are available in the literature on the impact of intravenous administration of anesthetics on laryngeal electromyographic (EMG) activity. The purpose of this study was to determine the influence of the two commonly used intravenous anesthetics (propofol and thiamylal) on EMG amplitude evoked from the recurrent laryngeal nerve (RLN) during thyroid surgery. A total of 40 patients were randomized to receive a bolus of propofol (0.5 mg/kg; n = 20) or thiamylal (1.5 mg/kg; n = 20) to increase anesthetic depth when the surgeon found patient movement intraoperatively. Evoked potentials were obtained before and every 1 minute after the administration of each agent for up to 5 minutes by stimulating the RLN. The magnitude of evoked potentials at each time point and hemodynamic response were compared within groups. The mean amplitude of evoked potentials did not change significantly after administration of either propofol or thiamylal (p > 0.05 within groups). Mean arterial pressure measured from 1 minute to 5 minutes was significantly lower in the propofol group than in the thiamylal group (p < 0.05). Heart rate measured within 5 minutes did not differ significantly within groups. Low dose of propofol (0.5 mg/kg) or thiamylal (1.5 mg/kg) did not affect EMG readings during neuromonitoring of the RLN in thyroid surgery. Our results show that thiamylal provides better hemodynamic stability than propofol, and is therefore a preferable agent to increase anesthesia depth and prevent further patient movement during intraoperative neuromonitoring.