目的:探讨甲状腺手术中氟比洛芬酯对丙泊酚—瑞芬太尼麻醉效果的影响。方法:将210例择期丙泊酚—瑞芬太尼麻醉下行甲状腺手术患者随机分为对照组和氟比洛芬酯组,每组105例。于切皮前30 min,对照组静脉注入等量生理盐水10mL,氟比洛芬酯组经静脉注入氟比洛芬酯注射液100 mg。分别记录患者麻醉前10 min (T0)、切皮时(T1)、切皮后10 min (T2)、切除腺体时 (T3)以及拔管时 (T4) 的血流动力学 (SBP、DBP、HR) 的变化以及术后口述描述评分(VRS)。结果:与对照组比较, 氟比洛芬酯组T14时SP、DP均降低,两组差别有统计学意义(Plt;005)。氟比洛芬酯组离开手术室时无痛率明显高于对照组,两组差别有统计学意义(Plt;005)。结论:氟比洛芬酯对丙泊酚—瑞芬太尼麻醉下行甲状腺手术患者血流动力学影响小,且减轻术后疼痛,术后恢复更为舒适。
【Abstract】Objective To explore the operative technique of endoscopic thyroidectomy and prevent its complications. Methods A retrospective analysis was made on the clinical data of 32 patients with benign thyroid diseases who were treated with endoscopic thyroidectomy between May 2002 and March 2005. Results Thirtytwo cases were successfully treated with the mean operation time 130 min(80～180 min). Twelve cases with thyroid adenomas and 20 cases with thyroid tubers were confirmed by histologic examinations. In this group, the postoperative complications included fat liquefaction in 2 cases and transient hoarseness in 1 case who recovered 3 months after operation. No parathyroid injury occurred. The drainage tubes were removed 2~3 days after operation. All of the patients were discharged 2~5 days after operation.Conclusion Endoscopic thyroidectomy is safe and feasible with favorable cosmetic effect.
【Abstract】ObjectiveTo study the applicatble value of absorbable biomedical membrane (ABMM) in thyroid operation.MethodsABMM (size 0.02 cm) was placed between trachea and the skin flap trachea and the anterior muscles of the neck, and between anterior muscles of neck and the skin flap after radical cure for thyroid cancer of thyroidectomy including one or two lobes. ResultsConglutination under the incision was significantly lighter in experiment group (153 cases ) than control group (139 cases) ( P＜0.05）, but the difference of complication between two groups was insignificant after postoperative followup for 6 weeks. ConclusionABMM can effectively prevent conglutination under the incision without increasing of postoperative complications.
目的 探讨经胸骨前径路内镜甲状腺手术的方法及其临床效果。 方法 采用经胸骨前径路内镜甲状腺手术治疗24例甲状腺良性肿瘤患者，并进行定期随访。 结果 23例手术顺利完成，1例因术中快速冰冻病理诊断为乳头状甲状腺癌而追加常规甲状腺癌根治术。平均手术时间为150 min，术中平均出血量30 ml。2例出现皮下气肿，4例出现胸部皮肤麻木。无喉返神经及甲状旁腺损伤,无术后出血、甲状腺危象等并发症出现。随访1~6个月，所有患者对美容效果非常满意，无近期肿瘤复发者。 结论 经胸骨前径路内镜甲状腺手术是一种美容效果较好的手术方法，手术操作空间的建立和术中控制出血是该术式的两大关键技术。
Dissections of the recurrent laryngeal nerves (RLN) were made on 50 cadavers (100 RLN). The right nerves were found to be anterior to the inferior thyroid artery in a half of cases and the left nerves were found more posterior to the artery (38 of 50). 64% of nerves branched off into 2 to 5 branches before entering the larynx. 89%of nerves tan medially to the suspensory ligment and 91% of nerves located inferior and somewhat superfical to the cornu before entering the laryx. Based on this finding, we instituted the policy of lingitunal dissection of the Berry’s ligament close the capsule of thyroid gland, 70 patients underwent operation (83 nerves), the nerves were exposed in 39 cases and unexposed in 44, there was no injury to the nerve in this serries. The authors believe that to familiarize the anatomy and the skillful technic is crucial to prevent injury to the RLN, and it is unnecessary to expose the RLN rountinely.
OBJECTIVE In order to investigate the opportunity of repair and prognosis of recurrent laryngeal nerve injuries after thyroidectomy. METHODS Twelve cases with recurrent laryngeal nerve injuries after thyroidectomy were immediately and delayed operated on nerve repair and reinnervation. In immediate operation, 5 cases were repaired by direct recurrent laryngeal nerve suture, and 1 case was treated by transposition of the phrenic nerve to the recurrent laryngeal nerve and sutured the adductor branch to the branch of ansa cervicalis. In delayed operation, 3 cases were treated by anastomosis the main trunk of ansa cervicalis to the adductor branch of recurrent laryngeal nerve, and 3 cases were operated on neuromuscular pedicle to reinnervate posterior cricoarytenoid muscle. RESULTS Followed up 6 months, the effect was excellent in 1 case who was immediately operated by selective reinnervation of the abductor and adductor muscles of the larynx, better in 9 cases, and poor in 2 cases who were delayed operated over 12 months. CONCLUSION It can be concluded that the earlier reinnervation is performed, the better prognosis is.
【摘要】目的探讨经乳晕入路腔镜甲状腺手术的可行性。方法回顾分析2007年12月2009年4 月采用经乳晕入路行腔镜甲状腺手术15例临床资料。结果术后患者均痊愈出院。手术时间90～200 min,平均135 min;术中出血20～60 mL,平均32 mL；均未出现喉返神经及甲状旁腺损伤等并发症;术后平均住院5 d。随访6 ～ 20个月,均无复发,患者对伤口满意。结论经乳晕入路腔镜甲状腺手术,安全可靠、并发症少、美容效果好、住院时间短,有应用前景。