目的 探讨超声刀在开放性小切口甲状腺手术中的应用效果。方法 总结我科于2004年4月至2007年12月期间对89例甲状腺良性疾病患者开展的开放性小切口(3～4 cm)甲状腺切除术，手术中采用超声刀代替传统的结扎和缝扎方法对甲状腺血管和腺体进行处理。结果 手术平均时间70(40～135) min，术中平均出血量15(5～20) ml，术后24 h平均切口引流量25(10～50) ml。无出血、神经、甲状旁腺损伤及其他并发症。切口Ⅰ类/甲级愈合，术后平均住院时间5(3～6) d。结论 超声刀应用于开放性小切口甲状腺切除，可以方便手术操作，提高手术效率，止血效果可靠，有特有的实用价值。
Objective To assess the feasibility and adequacy of Harmonic Scalpel in a totally laparoscopic total mesorectal excision (TME) and low,ultralow,colo-anal anastomoses for rectal cancer. Methods Excision of the mesorectum and low，ultralow site anastomoses were performed laparoscopically on 30 patients with low rectal cancer based on the concept of TME. Results All 30 TME were successfully completed by laparoscopic approach, and no one was converted to open procedures. A cholecystectomy and/or an ovariotomy were meanwhile performed laparoscopically for 3 patients with rectal cancer,and 1 patient with chronic cholesyctitis, gallstone,ovarian cyst and torsion of the ovary. The operation time was 155 min (115-320 min). Operative blood loss was 20 ml (5-80 ml).The time of bowel function returned and the time to resume postoperative diet was 1-2 days after the operation. Fourteen patients had postoperative analgesic requirement. Average hospital stay was 8 days (5-14 days) and there were no intraoperative and postoperative complications in all 30 patients.Conclusion Laparoscopic excision of the mesorectum and low,ultralow,coloanal anastomoses with Harmonic Scalpel for low rectal cancer is a perspective minimally invasive technique, which is feasible, safe, effective and has dramatic high rates of sphincter preservation with decreased postoperative pain, rapid recovery.
【Abstract】ObjectiveTo study the application of ultrasonically activated scalpel in laparoscopic intestinal adhesion release.MethodsIntestinal adhesion release with ultrasonically activated scalpel under laparoscope was performed in 29 patients suffered from intestinal adhesive obstruction after gynecological operation. ResultsAll operations were successfully performed, and none of them converted into open surgery. Intestinal disruption occurred durring operation in 2 patients with extensive intestinal denseadhesion which were mended successfully under laparoscope. The operative duration was 30-150 min (mean 45 min). Postoperative complications such as bowel leakage, bleeding, abdominal infection were not experienced. Postoperative hospital stay was 3-7 days (mean 4 days). No case had relapse symptom such as abdominal distention or pain after 1-24 months of followup. ConclusionCompared with electric scalpel, ultrasonically activated scalpel can improve the operative safety, lessen tissue damage, shorten operative time, and reduce the chance of relapse in laparoscopic operation in gynecology.
Objective To compare the efficacy and complication between harmonic scalpel and traditional electric knife in open thyroidectomy. Methods A total of 160 thyroid disease patients who underwent open thyroidectomy in The Fifth Affiliated Hospital of Southern Medical University from February 2016 to January 2017, were collected and divided into harmonic scalpel group and traditional electric knife group randomly, each group enrolled 80 patients. The efficacy of thyroidectomy, postoperative pain, and complication between the 2 groups were compared and analyzed. Results Compared with the traditional electric knife group, the operation time, intraoperative blood loss, postoperative drainage volume, postoperative drainage time, length of incision, and hospital stay were all significantly lower in the harmonic scalpel group (P<0.05). The incidences hoarseness, wound bleeding, hypoparathyroidism, and total complication in the harmonic scalpel group were all lower than those of the traditional electric knife group (P<0.05). The pain scores after operation in the harmonic scalpel group were significant lower than corresponding pain scores of the traditional electric knife group (P<0.05). Conclusion The harmonic scalpel could effectively improve the efficacy of open thyroidectomy, reduce the pain degree and the incidence of complication in thyroid disease patients.
Objective To assess clinical value of thyroidectomy by meticulous capsular dissection technique through neck incision approach in treatment of 75 patients with type Ⅰ substernal goiter. Methods The clinical data of 75 patients with type Ⅰ substernal goiter in the Department of General Surgery of the Central Hospital of Xiaogan from April 2013 to April 2017 were retrospectively analyzed. These patients received the surgical resection by the meticulous capsular dissection technique with an ultrasonic scalpel and a bipolar coagulation forcep through neck incision approach. Results There were 12 Hashimoto thyroiditis, 10 thyroid adenoma, 41 nodular goiter, and 12 thyroid carcinoma in the 75 patients with type Ⅰ substernal goiter. Five cases underwent the unilateral total thyroidectomy. Fifty-eight cases underwent the bilateral total thyroidectomy. The bilateral total thyroidectomy plus central lymph node dissection were performed in the 9 patients with thyroid carcinoma, the bilateral total thyroidectomy plus central lymph node dissection plus affected ipsilateral neck lymph node dissection were performed in the 3 patients with thyroid carcinoma. The average operative time was 100 min, the average intraoperative blood loss was 50 mL, the average postoperative hospital stay was 5 d. The rate of parathyroid injury was 2.7% (2/75), the rate of hypocalcemia caused by parathyroid injury was 2.7% (2/75). There were 3 cases (4.0%) of unilateral recurrent laryngeal nerve injury, 1 case (1.3%) of the outer branch of the upper laryngeal nerve injury. There were 2 cases of tracheal partial softening in the 75 patients. None of postoperative bleeding and seroma happened. No death and the tumor recurrence and metastasis of patients happened during follow-up period. Conclusions Preliminary results in this study show that operation of meticulous capsular dissection technique with an ultrasonic scalpel and a bipolar coagulation forcep through neck incision approach in treatment of type Ⅰ substernal goiter is safe and feasible, it could effectively reduce postoperative complications of thyroidectomy, and protect parathyroid and it’s function, recurrent laryngeal nerve, and superior laryngeal nerve.
Objective To compare the disadvantages and advantages of open thyroid surgery when using the harmonic scalpel (HS) vs conventional hemostasis (CH). Methods One hundred and fifty-one patients and 70 patients underwent thyroid surgery with HS or CH respectively. The tumor diameter, incisional length, the total operative time, thyroidectomy time, intraoperative bleeding volume, postoperative drainage volume and surgical complications were compared. The incisional length and the surgical complications in and after learning curve with harmonic scalpel were compared. Results There was no significant difference between the HS and CH group at baseline. Incisional length, total operative time, thyroidectomy time, intraoperative bleeding volume and postoperative drainage volume in HS group were significantly lower than those of CH group (P＜0.001); the surgical complications showed no significant difference between the HS and CH group (Pgt;0.05); the incisional length after learning curve was shorter than that in learning curve in HS group (P＜0.05); the surgical complications after learning curve were significantly lower than that in learning curve in HS group (P＜0.001). Conclusion HS provides significant advantages over conventional hemostasis in open thyroid surgery. However, it can’t be used in a blindly exclusive way but be combined with conventional knot tying appropriately.
ObjectiveTo evaluate the feasibility of clipless laparoscopic cholecystectomy (LC) to patients with calculous cholecystitis in acute inflammation stage. Methods The clinical data of 169 patients with calculous cholecystitis in acute inflammation stage who underwent clipless LC from December 2008 to July 2010 were analyzed. ResultsAll patients were successfully operated by LC except one case who suffered from gallbladder perforation and a conversion to open surgery was performed. The operation time ranged from 25-70 min (mean 38 min). The blood loss ranged from 10-200 ml (mean 22 ml). Peritoneal drainage was done in 38 patients, and the drainage time ranged from 1-6 d (mean 1.8 d). The time to out-of-bed activity was at 2 h after operation and the hospitalization time was 3-7 d (mean 3.5 d). There was no complication such as bile duct injury, hemorrhage, billiary leakage, and intra-abdominal infection. ConclusionWith improvement of operator’s experiences and skills, the clipless LC becomes feasible and safe for patients with calculous cholecystitis in acute inflammation stage.
ObjectivesTo systematically review the safety of harmonic scalpel and conventional resection in superficial parotidectomy.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and CBM databases were electronically searched to collect randomized controlled trials (RCTs) or cohort studies of harmonic scalpel and conventional resection in superficial parotidectomy from the inception of the database to December, 2018. Two reviewers independently screened literatures, extracted data and assessed risk of bias of the included studies. Then meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 10 studies involving 671 post-cesarean section patients (361 patients in harmonic scalpel group and 310 patients in conventional resection group) were included. The results of meta-analysis showed that: compared with conventional resection, harmonic scalpel had shorter operative time (MD=−23.82, 95%CI −31.20 to −16.44, P<0.000 01), less postoperative drain output (MD=−26.25, 95%CI −38.95 to −13.55, P<0.000 1), less intraoperative blood loss (MD=−23.78, 95%CI −28.64 to −18.91, P<0.000 01), shorter duration of hospital stay (MD=−1.19, 95%CI −2.14 to −0.23, P=0.02), and lower temporary facial nerve palsy rate (OR=0.27, 95%CI 0.14 to 0.50, P<0.000 1). However, there was no significant difference in the incidence of parotid gland leakage between two groups (OR=0.42, 95%CI 0.16 to 1.06, P=0.07).ConclusionsThe current evidence demonstrates that, compared to conventional resection, harmonic scalpel resection is safer. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.