中国微创外科杂志
中國微創外科雜誌
중국미창외과잡지
CHINESE JOURNAL OF MINIMALLY INVASIVE SURGERY
2015年
2期
136-139
,共4页
梁俊杰%胡友主%赵琼%李强
樑俊傑%鬍友主%趙瓊%李彊
량준걸%호우주%조경%리강
腔镜%甲状腺切除术%完全乳晕入路%隧道出血
腔鏡%甲狀腺切除術%完全乳暈入路%隧道齣血
강경%갑상선절제술%완전유훈입로%수도출혈
Endoscopy%Thyroidectomy%Complete areola approach%Tunnel bleeding
目的：探讨完全乳晕入路腔镜甲状腺切除术隧道出血的部位及处理方法。方法回顾分析2005年6月～2014年3月行完全乳晕入路腔镜甲状腺切除术1080例中发生的由穿刺套管在穿刺过程中致皮下穿刺隧道活动性出血的37例临床资料，包括出血隧道、出血部位、手术时间、术中出血量、术后引流量、术后住院时间、术后并发症。结果隧道出血发生率3．4％（37／1080），其中观察隧道出血发生率2．7％（29／1080），明显高于主操作隧道0．2％（2／1080）及辅操作隧道0．6％（6／1080）（χ2＝34．830，P＝0．000）。中段出血发生率2．9％（31／1080），明显高于外口0．5％（5／1080）及内口0．1％（1／1080）（χ2＝43．524，P＝0．000）。37例均术中成功处理隧道出血，无术后再出血。手术时间（112．6±17．5）min，术中出血量（22．5±9．6）ml，术后2天引流量（91．2±17．9）ml，术后住院时间（3．8±1．5）d。3例术后局部皮肤瘀斑、1例皮下积液，对症治疗治愈。结论出血多发生于观察隧道及隧道中段。隧道外口出血采用超声刀凝血，隧道中段及内口出血采用经皮缝扎压迫止血，效果良好。
目的：探討完全乳暈入路腔鏡甲狀腺切除術隧道齣血的部位及處理方法。方法迴顧分析2005年6月～2014年3月行完全乳暈入路腔鏡甲狀腺切除術1080例中髮生的由穿刺套管在穿刺過程中緻皮下穿刺隧道活動性齣血的37例臨床資料，包括齣血隧道、齣血部位、手術時間、術中齣血量、術後引流量、術後住院時間、術後併髮癥。結果隧道齣血髮生率3．4％（37／1080），其中觀察隧道齣血髮生率2．7％（29／1080），明顯高于主操作隧道0．2％（2／1080）及輔操作隧道0．6％（6／1080）（χ2＝34．830，P＝0．000）。中段齣血髮生率2．9％（31／1080），明顯高于外口0．5％（5／1080）及內口0．1％（1／1080）（χ2＝43．524，P＝0．000）。37例均術中成功處理隧道齣血，無術後再齣血。手術時間（112．6±17．5）min，術中齣血量（22．5±9．6）ml，術後2天引流量（91．2±17．9）ml，術後住院時間（3．8±1．5）d。3例術後跼部皮膚瘀斑、1例皮下積液，對癥治療治愈。結論齣血多髮生于觀察隧道及隧道中段。隧道外口齣血採用超聲刀凝血，隧道中段及內口齣血採用經皮縫扎壓迫止血，效果良好。
목적：탐토완전유훈입로강경갑상선절제술수도출혈적부위급처리방법。방법회고분석2005년6월～2014년3월행완전유훈입로강경갑상선절제술1080례중발생적유천자투관재천자과정중치피하천자수도활동성출혈적37례림상자료，포괄출혈수도、출혈부위、수술시간、술중출혈량、술후인류량、술후주원시간、술후병발증。결과수도출혈발생솔3．4％（37／1080），기중관찰수도출혈발생솔2．7％（29／1080），명현고우주조작수도0．2％（2／1080）급보조작수도0．6％（6／1080）（χ2＝34．830，P＝0．000）。중단출혈발생솔2．9％（31／1080），명현고우외구0．5％（5／1080）급내구0．1％（1／1080）（χ2＝43．524，P＝0．000）。37례균술중성공처리수도출혈，무술후재출혈。수술시간（112．6±17．5）min，술중출혈량（22．5±9．6）ml，술후2천인류량（91．2±17．9）ml，술후주원시간（3．8±1．5）d。3례술후국부피부어반、1례피하적액，대증치료치유。결론출혈다발생우관찰수도급수도중단。수도외구출혈채용초성도응혈，수도중단급내구출혈채용경피봉찰압박지혈，효과량호。
Objective To analyze and explore the management for tunnel bleeding during endoscopic thyroidectomy via complete areola approach . Methods A retrospective analysis was made on clinical data of 37 patients suffering tunnel bleeding caused by trocars during puncture out of 1080 cases of endoscopic thyroidectomy via complete areola approach from June 2005 to March 2014.Parameters reviewed included bleeding tunnel , bleeding site, operative time, operative blood loss, postoperative drainage, postoperative hospital stay , and postoperative complications . Results The total incidence of tunnel bleeding was 3.4%(37/1080).Hereinto, the incidence of bleeding in observation tunnel was 2.7%(29/1080), which was significantly higher than that in the main operating tunnel (0.2%, 2/1080) and the auxiliary operating tunnel (0.6%, 6/1080) (χ2 =34.830, P=0.000).The incidence of bleeding in the middle part of the tunnel was 2.9% (31/1080), which was significantly higher than that at the exterior edge (0.5%, 5/1080) and the inner edge (0.1%, 1/1080) (χ2 =43.524, P=0.000).The tunnel bleeding was successfully treated in 37 cases without postoperative bleeding .The mean operating time was 112.6 ±17.5 min;the mean intraoperative blood loss was 22.5 ±9.6 ml;the mean drainage volume after 2 postoperative days was 91.2 ±17.9 ml;the mean postoperative hospital stay was 3.8 ±1.5 d.Local skin ecchymosis occurred in 3 cases and subcutaneous hydrops occurred in 1 case postoperatively , which were recovered after symptomatic treatment . Conclusions Bleeding often occurs in observation tunnel and the middle part of the tunnel . It is effective to treat bleeding at the exterior edge by using harmonic scalpel , and in the middle part of the tunnel and at the inner edge by using percutaneous suturing .
