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find Author "夏长军" 2 results
  • 用累积和分析方法研究经口腔前庭入路腔镜甲状腺手术的学习曲线

    目的探讨经口腔前庭入路腔镜甲状腺手术的学习曲线,为学习该术式的医生提供参考。方法回顾性分析76例经口腔前庭入路腔镜甲状腺手术患者的临床资料,患者来源于2020年9月1日至2021年8月31日期间河南中医药大学第一附属医院普外科一病区,由有开放手术经验的同一主刀医师最初完成。采用累积和(cumulative sum,CUSUM)分析方法绘制学习曲线,研究具有开放手术经验的主刀医师从初步学习阶段过渡到熟练掌握阶段需要的最少学习病例数,比较不同学习曲线阶段患者的手术时间、术中出血量、术后引流量、术后住院时间、淋巴结清扫数目及术后并发症发生率指标。结果本研究中76例患者的中位手术时间为127.00 min。采用CUSUM分析方法绘制学习曲线,最佳拟合方程为CUSUMn=–0.394 4 n2+24.348 n+243.02(P<0.05,拟合系数=0.831)。CUSUM学习曲线在手术病例数第24例时达峰值,以此为界将学习曲线划分为学习提高期(n=24)和熟练掌握期(n=52)2个阶段,2个阶段患者的基线资料如年龄、性别、手术部位、肿瘤性质及肿瘤直径方面比较差异均无统计学意义(P>0.05),具有可比性。学习提高期的手术时间[中位数(上、下四分位数)]长于熟练掌握期 [163.50(136.25,194.50)min比120.00(110.00,135.00),Z=–5.144,P<0.001],且学习提高期术后并发症发生率高于熟练掌握期(50.0%比14.5%,χ2=6.474,P=0.011),2个阶段的术中出血量、术后引流量、术后住院时间及淋巴结清扫数目比较差异无统计学意义(P>0.05)。结论从本研究的结果提示,对于有腔镜经验的甲状腺专科医师,经口腔前庭入路腔镜甲状腺手术有明显的学习曲线,在完成24例手术后可认为从初步学习阶段过渡到熟练掌握阶段。

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  • Research status and prospect of mandibular sensory dysfunction after transoral endoscopic thyroidectomy vestibular approach

    ObjectiveTo summarize the research status of mandibular sensory dysfunction after transoral endoscopic thyroidectomy vestibular approach (TOETVA), and explore its potential treatment methods and existing problems, and provide ideas and methods for future clinical treatments or research. MethodThe domestic and foreign literatures about peripheral nerve injury and its treatment after TOETVA were searched and reviewed. ResultsMental nerve injury was considered to be the main cause of mandibular sensory dysfunction after TOETVA. Due to the lack of unified definitions and assessment standards, the true incidence remained unclear. In order to reduce the risk of mental nerve injury, methods such as exposing the mental nerve and combining vestibular approaches during surgery had certain advantages. In terms of treatment, several methods promoting nerve repair were noteworthy, including B vitamins, nerve growth factors, physical therapy and so on. In addition, some auxiliary treatments of Traditional Chinese Medicine also showed effectiveness in promoting nerve regeneration. ConclusionsIt is essential to avoid damage to the mental nerve and mandibular tissues during surgery. For patients with significant complaints postoperatively, active treatment should be pursued. Establishing objective and quantifiable standards for evaluating mandibular sensory dysfunction and seeking effective clinical plans through a multidisciplinary approach may be the direction for future research.

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