Analysis on the superiority of bipolar coagulation forceps combined with meticulous capsular dissection technique in thyroidectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Dejie , LIN Guoliang , ZHANG Ming , YANG Xianrong , ZHANG Ditian , LIAO Mingxing ,  WANG Qicai

Department of The Third General Surgery, Longyan First Hospital, Fujian Medical University, Longyan, Fujian 364000, P.R.China;

Corresponding author：

WANG Qicai, Email: wangqc88@163.com

Keywords：

bipolar coagulation forceps; meticulous capsular dissection technique; thyroidectomy

DOI：

10.7507/1007-9424.201607055

Video：

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Objective To investigate the value of bipolar coagulation forceps combined with meticulous capsular dissection technique in thyroidectomy. Methods Information of 203 patients with thyroid neoplasms who underwent thyroidectomy in Longyan First Hospital from January 2014 to July 2015, were collected retrospectively. Patients were divide into control group (98 patients who had received conventional thyroidectomy) and observation group (105 patients who had received bipolar coagulation forceps combined with meticulous capsular dissection technique in thyroidectomy) according to the surgery type. Then comparison of 2 groups in incidence of recurrent laryngeal nerve injury, temporary hypocalcemia, temporary or permanent hypoparathyroidism, serum parathyroid hormone (PTH) and serum calcium was performed. Results All the operation of 203 patients went smoothly, and no operative death happened. Operation time of control group and observation group showed no obvious difference〔(68.24±16.59) minvs. (64.78±14.20) min,P>0.05〕, but the intraoperative blood loss of control group was more than observation group〔(25.44±8.35) mLvs. (16.58±5.44) mL,P<0.05〕. There were 25 patients suffered from temporary hypocalcemia after operation, including 18 patients in control group and 7 patients in observation group. There were 38 patients suffered from temporary hypoparathyroidism after operation. including 24 patients in control group and 14 patients in observation group. The incidences of temporary hypocalcemia (χ²=6.426,P<0.05) and temporary hypoparathyroidism (χ²=4.147,P<0.05) were both lower in observation group than corresponding index of control group. But no one suffered from permanent hypoparathyroidism. There were 17 patients existent hoarseness in the control group and 14 patients in observation group, but no one had cough caused by superior laryngeal nerve injury of all the patients, and the incidence of hoarseness of 2 groups had no significant difference (χ²=0.637,P>0.05). Conclusions Bipolar coagulation forceps combined with meticulous capsular dissection technique in thyroidectomy could reduce the temporary hypocalcemia and temporary hypoparathyroidism, and provide the better protection to the blood supply of parathyroid. In addition, bipolar coagulation forceps could reduce thermal injury and heighten hemostasis. So, it is worthy to perform bipolar coagulation forceps combined with meticulous capsular dissection technique in thyroidectomy.

Citation： ZHANG Dejie, LIN Guoliang, ZHANG Ming, YANG Xianrong, ZHANG Ditian, LIAO Mingxing, WANG Qicai. Analysis on the superiority of bipolar coagulation forceps combined with meticulous capsular dissection technique in thyroidectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(3): 322-327. doi: 10.7507/1007-9424.201607055 Copy

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2.	Hayward NJ, Grodski S, Yeung M,et al. Recurrent laryngeal nerve injury in thyroid surgery: a review. ANZ J Surg, 2013, 83(1-2): 15-21.
3.	宋斌. 甲状腺被膜内次全切除术与被膜外次全切除术的近期并发症比较. 实用临床医药杂志, 2013, 17(16): 36-38.
4.	Vassiliou I, Tympa A, Arkadopoulos N,et al. Total thyroidectomy as the single surgical option for benign and malignant thyroid disease: a surgical challenge. Arch Med Sci, 2013, 9(1): 74-78.
5.	秦坚, 徐晓波, 周致圆, 等. 甲状腺手术方式和喉返神经损伤的关系. 中国普外基础与临床杂志, 2014, 21(9): 1149-1151.
6.	Tomoda C, Hirokawa Y, Uruno T,et al. Sensitivity and specificity of intraoperative recurrent laryngeal nerve stimulation test for predicting vocal cord palsy after thyroid surgery. World J Surg, 2006, 30(7): 1230-1233.
7.	Haugen BR, Alexander EK, Bible KC,et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid, 2016, 26(1): 1-133.
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9.	中华医学会内分泌学分会, 中华医学会外科学分会, 中国抗癌协会头颈肿瘤专业委员会, 等. 甲状腺结节和分化型甲状腺癌诊治指南. 中国肿瘤临床, 2012, 39(17): 1249-1272.
10.	中国医师协会外科医师分会甲状腺外科医师委员会. 甲状腺及甲状旁腺手术中神经电生理监测临床指南(中国版). 中国实用外科杂志, 2013, 33(6): 470-474.
11.	王卓颖, 孙团起, 吴毅, 等. 中央区淋巴结清扫在甲状腺乳头状微小癌治疗中的意义(附 10 年 1 048 例报告). 中国实用外科杂志, 2014, 34(1): 93-96.
12.	中国医师协会外科医师分会甲状腺外科医师委员会. 甲状腺手术中甲状旁腺保护专家共识. 中国实用外科杂志, 2015, 35(7): 731-736.
13.	周龙翔, 俞冬, 徐军, 等. 采用精细化被膜解剖+喉返神经显露法行甲状腺腺叶切除 452 例临床分析. 中国普外基础与临床杂志, 2013, 20(6): 638-642.
14.	Bliss RD, Gauger PG, Delbridge LW. Surgeon’s approach to the thyroid gland: surgical anatomy and importance of technique. World J Surg, 2000, 24(8): 891-897.
15.	杨海瑞, 董庆申. 精细被膜解剖法在甲状腺手术中预防喉返神经与甲状旁腺损伤的应用. 中国微创外科杂志, 2014, 14(9): 802-804.
16.	Gil Z, Patel SG. 甲状腺癌手术——Memorial Sloan-Kettering Cancer Center经验(一). 中华耳鼻咽喉头颈外科杂志, 2011, 46(9): 787-791.
17.	梁健文, 张有利, 杨小静, 等. 甲状腺癌全切术中应用被膜解剖技术对甲状旁腺功能及喉返神经的影响. 河南医学研究, 2016, 25(2): 237-239.
18.	Ahmed M, Aurangzeb, Abbas S,et al. Should we routinely expose recurrent laryngeal nerve(s) during thyroid surgery? J Coll Physicians Surg Pak, 2013, 23(3): 186-189.
19.	Ellis H. Anatomy of the thyroid and parathyroid glands. Surgery, 2007, 25(11): 467-468.
20.	朱思翔. 鼻内镜下双极电凝与微波治疗老年难治性鼻出血的临床疗效. 中国老年学杂志, 2016, 36(15): 3776-3778.
21.	邓伟光, 郭晓兰, 杜红. 超声刀联合高频双极电凝对甲状腺癌患者喉返神经及甲状旁腺的影响. 蚌埠医学院学报, 2016, 41(7): 917-919.
22.	Bulsara KR, Sukhla S, Nimjee SM. History of bipolar coagulation. Neurosurg Rev, 2006, 29(2): 93-96.
23.	邱堃, 王一森, 吴元清. 双极电凝系统与超声刀在甲状腺手术中应用效果观察. 中华普外科手术学杂志(电子版), 2015, 9(6): 47-49.
24.	李加涌, 桑剑锋, 姚永忠, 等. 双极电凝镊在开放性甲状腺手术中的临床应用. 中国普外基础与临床杂志, 2016, 23(1): 75-78.
25.	魏涛, 朱精强. 甲状腺手术理念进展与新型手术器械在甲状腺外科中的应用. 中国普外基础与临床杂志, 2011, 18(2): 220-224.
26.	李卫民, 王芳, 王艳明, 等. LigaSure 与双极电刀在腹腔镜巨大子宫切除术中的联合应用. 腹腔镜外科杂志, 2015, 20(12): 896-898.

1. Giordano D, Valcavi R, Thompson GB,et al. Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1 087 patients and review of the literature. Thyroid, 2012, 22(9): 911-917.
2. Hayward NJ, Grodski S, Yeung M,et al. Recurrent laryngeal nerve injury in thyroid surgery: a review. ANZ J Surg, 2013, 83(1-2): 15-21.
3. 宋斌. 甲状腺被膜内次全切除术与被膜外次全切除术的近期并发症比较. 实用临床医药杂志, 2013, 17(16): 36-38.
4. Vassiliou I, Tympa A, Arkadopoulos N,et al. Total thyroidectomy as the single surgical option for benign and malignant thyroid disease: a surgical challenge. Arch Med Sci, 2013, 9(1): 74-78.
5. 秦坚, 徐晓波, 周致圆, 等. 甲状腺手术方式和喉返神经损伤的关系. 中国普外基础与临床杂志, 2014, 21(9): 1149-1151.
6. Tomoda C, Hirokawa Y, Uruno T,et al. Sensitivity and specificity of intraoperative recurrent laryngeal nerve stimulation test for predicting vocal cord palsy after thyroid surgery. World J Surg, 2006, 30(7): 1230-1233.
7. Haugen BR, Alexander EK, Bible KC,et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid, 2016, 26(1): 1-133.
8. NCCN. NCCN clinical practice guidelines in oncology. Thyroid carcinoma. Version 1. 2011. .
9. 中华医学会内分泌学分会, 中华医学会外科学分会, 中国抗癌协会头颈肿瘤专业委员会, 等. 甲状腺结节和分化型甲状腺癌诊治指南. 中国肿瘤临床, 2012, 39(17): 1249-1272.
10. 中国医师协会外科医师分会甲状腺外科医师委员会. 甲状腺及甲状旁腺手术中神经电生理监测临床指南(中国版). 中国实用外科杂志, 2013, 33(6): 470-474.
11. 王卓颖, 孙团起, 吴毅, 等. 中央区淋巴结清扫在甲状腺乳头状微小癌治疗中的意义(附 10 年 1 048 例报告). 中国实用外科杂志, 2014, 34(1): 93-96.
12. 中国医师协会外科医师分会甲状腺外科医师委员会. 甲状腺手术中甲状旁腺保护专家共识. 中国实用外科杂志, 2015, 35(7): 731-736.
13. 周龙翔, 俞冬, 徐军, 等. 采用精细化被膜解剖+喉返神经显露法行甲状腺腺叶切除 452 例临床分析. 中国普外基础与临床杂志, 2013, 20(6): 638-642.
14. Bliss RD, Gauger PG, Delbridge LW. Surgeon’s approach to the thyroid gland: surgical anatomy and importance of technique. World J Surg, 2000, 24(8): 891-897.
15. 杨海瑞, 董庆申. 精细被膜解剖法在甲状腺手术中预防喉返神经与甲状旁腺损伤的应用. 中国微创外科杂志, 2014, 14(9): 802-804.
16. Gil Z, Patel SG. 甲状腺癌手术——Memorial Sloan-Kettering Cancer Center经验(一). 中华耳鼻咽喉头颈外科杂志, 2011, 46(9): 787-791.
17. 梁健文, 张有利, 杨小静, 等. 甲状腺癌全切术中应用被膜解剖技术对甲状旁腺功能及喉返神经的影响. 河南医学研究, 2016, 25(2): 237-239.
18. Ahmed M, Aurangzeb, Abbas S,et al. Should we routinely expose recurrent laryngeal nerve(s) during thyroid surgery? J Coll Physicians Surg Pak, 2013, 23(3): 186-189.
19. Ellis H. Anatomy of the thyroid and parathyroid glands. Surgery, 2007, 25(11): 467-468.
20. 朱思翔. 鼻内镜下双极电凝与微波治疗老年难治性鼻出血的临床疗效. 中国老年学杂志, 2016, 36(15): 3776-3778.
21. 邓伟光, 郭晓兰, 杜红. 超声刀联合高频双极电凝对甲状腺癌患者喉返神经及甲状旁腺的影响. 蚌埠医学院学报, 2016, 41(7): 917-919.
22. Bulsara KR, Sukhla S, Nimjee SM. History of bipolar coagulation. Neurosurg Rev, 2006, 29(2): 93-96.
23. 邱堃, 王一森, 吴元清. 双极电凝系统与超声刀在甲状腺手术中应用效果观察. 中华普外科手术学杂志(电子版), 2015, 9(6): 47-49.
24. 李加涌, 桑剑锋, 姚永忠, 等. 双极电凝镊在开放性甲状腺手术中的临床应用. 中国普外基础与临床杂志, 2016, 23(1): 75-78.
25. 魏涛, 朱精强. 甲状腺手术理念进展与新型手术器械在甲状腺外科中的应用. 中国普外基础与临床杂志, 2011, 18(2): 220-224.
26. 李卫民, 王芳, 王艳明, 等. LigaSure 与双极电刀在腹腔镜巨大子宫切除术中的联合应用. 腹腔镜外科杂志, 2015, 20(12): 896-898.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis on the superiority of bipolar coagulation forceps combined with meticulous capsular dissection technique in thyroidectomy

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