头灯放大镜辅助下Focus超声刀甲状腺切除术和传统手术的比较

目的 探索头灯放大镜辅助下Focus超声刀甲状腺切除术相对于传统手术的优势和技术要点。方法 自2009年9月至2011年5月在头灯放大镜辅助下采用Focus超声刀为主要手术切割工具完成甲状腺切除术211例。采用病例-对照研究的方法，选取2008年6月至2009年8月传统手术方法行甲状腺切除术230例为对照组。比较两组一般临床参数、切口长度、手术时间、术中出血量、术后引流情况、并发症、术后住院天数等指标。结果 两组临床参数相近，有可比性。相对于传统手术组，Focus超声刀组平均切口长度小、手术时间短、术中出血量和术后引流量少，差异有统计学意义。微创手术组88.2%无需放置引流管，常规手术组均放置引流胶管。两组手术并发症率和术后住院天数相近，差异无统计学意义。结论 头灯放大镜辅助下Focus超声刀甲状腺切除术切口小、手术时间短、术中出血少、术后引流量少，不增加并发症率，符合微创外科原则。

Comparison between headlight loupe assisted focus harmonic scalpel and traditional operative method for thyroidectomy

Objective To explore the advantages of thyroidectomy with harmonic scalpel assisted by headlight-loupes compared with conventional thyroidectomy with surgical electrocautery technique.Methods A total of 211 consecutive thyroidecotmies performed with harmonic scalpel assisted by headlight loupes(Harmonic scalpel group,HS)from Sep.2009 to May.2011 were retrospectively studied,and 230 thyroidecotmies with conventional electrocautery techniques(conventional surgery group,CS) from Jun.2008 to Aug.2009 were set as controls.Incision length,operating time,intraoperative blood loss,postoperative drainage,complications,and postoperative hospital stay were compared between these two groups.Results Demographic data of both groups were comparable.Compared with CS group,HS group had a shorter average incision length(4.12±0.76 cm vs.5.10±0.64 cm,P=0.012),shorter average operating time(35.23±15.58 min vs.50.31±20.10 min,P=0.007),less intraoperative blood loss(15.22±17.23 mL vs.28.10±10.00 mL,P=0.002),and less postoperative drainage(3.55±1.24 mL vs.25.26±5.37mL,P=0.000).Drainage tubes were needed in all operations in CS group,whereas only 11.8% operations needed a drainage tube in HS group.No statistic significances were found in operation complications and postoperative hospital stay between two groups.Conclusion Harmonic scalpel thyroidectomy assisted by headlight loupes has the benefits of shorter incision,shorter operating time,less intraoperative blood loss,and less postoperative drainage,and is in accordant to principles of minimally invasive surgery.