Abstract:

 Objective To investigate the effect of harmonic scalpel in open small incision thy-roidectomy, and observe the postoperative stress reactions, serum calcium level and recurrent laryngeal nerve injury（RLNI）. Methods Eighty cases of patients undergoing thyroidectomy in our hospital were enrolled in the study. According to different surgical Methods, the patients were divided into the observation group and the control group. The control group（n=40）were treated by conventional thyroidectomy, while the observation group（n=40）were treated through a small incision for thyroidectomy and harmonic scalpel was used during the operation in observation group. The operation time, intraoperative blood loss and postoperative drainage volume were compared between the two groups. The levels of white blood cell count（WBC）, C reactive protein（CRP）, procalcition（PCT）were detected before operation and 3 days after operation. The degree of RLNI and changes of blood calcium were monitored. Results The operation time, intraoperative blood loss and postoperative drainage volume in the observation group were significantly less than those in the control group （all P values <0.05）. WBC, CRP, PCT levels were increased significantly in two groups, and the increase was more significant in the control group than in the observation group （all P values <0.05）. The incidence rates of hypocalcemia and transient RLNI were significantly higher in the control group than the observation group （42.5% and 20.0% vs 17.5% and 5.0%）（all P values <0.05）. Conclusion There is an obvious superiority of harmonic scalpel in open small?incision thyroidectomy than conventional thyroidectomy，such as shorter operation time，less blood loss, lower traumatic reactions after operation, and less serum calcium disorder and RLNI.

Key words: harmonic scalpel, traumatic stress reactions, recurrent laryngeal nerve injury, calcium metabolism, thyroidectomy

摘要：

目的 探讨超声刀在开放小切口甲状腺切除术中应用疗效，并观察术后患者创伤应激反应、血清钙离子水平及喉返神经（RLN）损伤情况。方法 以我院进行甲状腺切除术患者80例为研究对象，根据患者则术式不同分为观察组与对照组，对照组（40例）予以传统甲状腺切除术，观察组（40例）予以超声刀小切口甲状腺切除术。比较两组手术时间、术中出血量、术后引流量等手术情况，并检测两组术前、术后3d白细胞计数（WBC）、C反应蛋白（CRP）、降钙素原（procalcition，PCT）等术后创伤应激水平，监测喉返神经损伤程度及血钙变化情况。结果 观察组手术时间、术中出血量及术后引流量等手术情况均明显优于对照组，差异均显著（P<0.05）；两组WBC、CRP、PCT等创伤应激指标较术前均显著升高，且对照组上升幅度均明显高于观察组，差异显著（P<0.05）；对照组低血钙发生率42.5％，明显高于观察组20.0%，组间差异显著（P<0.05）；对照组暂时性RLNI17.5%，明显高于观察组5.0%。结论 超声刀在开放性小切口甲状腺切除术中可有效降低术后创伤应激反应，减少钙代谢紊乱及喉返神经损伤，且手术时间短、出血量少，手术效果显著。

关键词: 创伤应激反应, 钙代谢, 喉返神经损伤 , 超声刀, 甲状腺切除术