| 摘要: |
| 目的 探讨手术消毒前超声定位在甲状腺疾病的手术治疗中的临床实用价值。 方法 对80例甲状腺多发结节患者,于手术消毒前由术者行超声定位,观测病灶个数、病灶于上下极分布情况以及距后包膜的距离;并对病灶手术切除率、手术探查时间、声嘶、低钙并发症发生率进行统计,与未行超声定位的80例甲状腺多发结节患者进行对照。 结果 80例患者术中按超声所观测数据确定的位置均能迅速找到病灶,病灶切除率为93.75％(75/80),多发性结节患者能缩短探查时间,结节距离后包膜5 mm以上者无需费时显露保护喉返神经,仅70.00%(56/80)显露喉返神经。未使用超声定位组对5 mm以下位置非表浅结节,均只能留作随访,病灶切除率76.25％(61/80),对临床可疑恶性、探查无法触及者,仅能做大范围切除活检(同侧叶次全切除),喉返神经显露达92.50%(74/80)。在手术探查时间、病灶切除率和喉返神经显露率方面两组间的差异有统计学意义(P<0.01)。两组中除1例因癌结节位于喉返神经入喉处术后出现声音略低外,均未发生严重并发症。 结论 甲状腺疾病麻醉后消毒前超声定位,有助于了解甲状腺病灶的数量及与周围组织的三维关系,有利于术中迅速找到并准确切除病灶,是一种既能提高手术精确性、提高病灶切除率,又能降低手术难度的实用性很强的方法。 |
| 关键词: 超声检查 术前定位 甲状腺疾病 消毒 |
| DOI：10.16781/j.0258-879x.2016.01.0102 |
| 投稿时间：2015-05-16修订日期：2015-09-06 |
| 基金项目:第二军医大学军事医学专项基金(2013JS19). |
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| Application of ultrasonic positioning before sterilization in surgical treatment of thyroid disease |
| HU Wei*,LIU Zheng,ZHANG Wen,YAO Zhi-wei |
(Department of Thyroid and Breast Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*Corresponding author.) |
| Abstract: |
| Objective To investigate the clinical value of ultrasonic positioning before sterilization in surgical treatment of thyroid disease. Methods A total of 80 patients with multiple thyroid lesions received ultrasonic positioning before sterilization for surgical treatment. We observed the number, location (in the upper and/or lower pole), and its distance to the posterior envelope. We also recorded the resection rate, the exploration time, and the incidences of complications(hoarseness and hypocalcaemia). Another 80 patients who did not receive ultrasonic positioning served as the controls. Results The lesions were rapidly identified in the ultrasonic positioning group, with the resection rate being 93.75% (75/80) and the exploration time being significantly shorter for patients with multiple lesions; moreover, ultrasonic positioning mades it unnecessary to expose the recurrent laryngeal nerve when the nodule was more than 5 mm away from the posterior envelope, so only 70.00% (56/80) of the patients exposed their recurrent laryngeal nerve. In control group, follow-up was the only available solution for the non-superficial nodules less than 5 mm, with the resection rate being only 76.25% (61/80); the only way to deal with dubious lesions was subtotal thyroidectomy, with the exposure rate of the recurrent laryngeal nerve being 92.50% (74/80). Significant differences were found between ultrasonic and non-ultrasonic groups in terms of resection rate and the exposure rate of the recurrent laryngeal nerve (P<0.01). One patient suffered from a slight deep voice after the operation due to the position of the cancerous node (close to the entrance to the throat of the recurrent laryngeal nerve), and no other patients suffered from severe postoperative complications. Conclusion Post-anesthesia ultrasonic positioning before sterilization can help to understand the numbers of thyroid lesions and their 3-dimensional distribution, and shorten the exploration time. So it is a technique that can not only improve the surgical accuracy and resection rate, but also reduce the difficulty of the surgery. |
| Key words: ultrasonography preoperative positioning thyroid disease disinfection |
