Objective: To compare the efficacies of the two techniques of "micro-hemostasis and micro-cutting" with straight bipolar electrocoagulation forceps and traditional clamp-ligation for hemostasia in thyroid surgery. Methods: A total of 228 patients who underwent surgical treatment for thyroid neoplasms in our hospital between January 2015 and December 2018 were retrospectively analyzed, including 50 males and 178 females, aged 23-68 years old. Of those, 150 cases as electric knife group received traditional thyroid surgery between January 2015 and December 2018 and 78 cases as bipolar electrocoagulation group received thyroid surgery by using the technique of bipolar electrocoagulation with meticulous anatomy between January 2018 and December 2018. The total operation time, single operation time, intraoperative hemorrhage, postoperative drainage volume on the first day, postoperative hoarseness and hypocalcemia were compared between the two groups. SPSS 16.0 was used to analyze the data. Results: The total operation time and intraoperative hemorrhage in the bipolar electrocoagulation group were significantly lower than those in the electric knife group ((59.33±18.29)min vs (77.21±25.39)min, (14.83±9.22)ml vs (36.86±11.80)ml, all P<0.01). The single operation time of the bipolar electrocoagulation group was shorter than that of the electric knife group((10.25±6.16) min vs (20.34±7.24)min, (16.25±7.15)min vs (35.68±8.25)min, (12.12±5.25)min vs (20.68±7.26)min, t value was 3.948,16.262,8.238, all P<0.01).There was no significant difference between the two groups in postoperative drainage volume on the first day (P>0.05) and the incidence of postoperative hoarseness (P>0.05), while the incidence of hypocalcemia in the bipolar electrocoagulation group(10.26%) was lower than that in the electric knife group(21.33%,χ(2)=4.353, P<0.05). Conclusions: The fine dissection for thyroid operation can be achieved by using straight bipolar electrocoagulation tweezers. The use of "micro-hemostasis" and "micro-cutting" technique with bipolar electrocoagulation tweezers can greatly reduce intraoperative bleeding, operation time and postoperative complication.
目的： 对比采用直型双极电凝镊"微凝切"技术进行全程精细化解剖与传统电刀切割结扎止血技术在甲状腺手术中的应用效果。 方法： 选取2015年1月至2018年12月因甲状腺肿瘤于云南省肿瘤医院行手术治疗的228例患者为研究对象，其中男50例，女178例，年龄23~68岁。2015年1月至2018年12月150例常规开放性手术患者作为电刀组，2018年1—12月开展双极电凝"微凝切"技术和全程精细化解剖技术的78例患者作为双极电凝镊组。比较两组患者总手术时间、单项操作时间、术中出血量、术后第1天引流量、术后声嘶症状、低钙血症的症状。应用SPSS 16.0软件对数据进行统计学分析。 结果： 双极电凝镊组总手术时间（59.33±18.29）min、术中出血量（14.83±9.22）ml明显低于电刀组[分别为（77.21±25.39）min、（36.86±11.80）ml，t值分别为5.517和14.361，P值均<0.01]、单项操作时间比较，双极电凝镊组单纯一侧腺叶切除（10.25±6.16）min、甲状腺全切除（16.25±7.15）min、一侧Ⅵ区淋巴切除（12.12±5.25）min均短于电刀组[分别为（20.34±7.24）min、（35.68±8.25）min、（20.68±7.26）min，t值分别为3.948、16.262、8.238，P值均<0.01]。双极电凝镊组术后第1天引流量以及术后不同程度声音嘶哑总发生率和电刀组无明显差异（P值均>0.05）；双极电凝镊组不同程度手足麻木等低钙血症总发生率为10.26%低于电刀组的21.33%（χ(2)=4.353，P<0.05）。 结论： 采用直型双极电凝镊"微凝切"技术进行全程精细化解剖可以减少术中出血、手术实际操作时间和术后并发症出现率。.
Keywords: Electrocoagulation; Meticulous dissection technique; Rehabilitation; Thyroidectomy.