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首页> 外文期刊>World Journal of Surgical Oncology >Total thyroidectomy with ultrasonic dissector for cancer: multicentric experience
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Total thyroidectomy with ultrasonic dissector for cancer: multicentric experience

机译：甲状腺全切术联合超声解剖器治疗癌症：多中心经验

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Background We conducted an observational multicentric clinical study on a cohort of patients undergoing thyroidectomy for thyroid carcinoma. The aim of this study was to evaluate the benefits of the use of ultrasonic dissector (UAS) vs. the use of a conventional technique (vessel clamp and tie) in patients undergoing thyroid surgery for cancer. Methods From June 2009 to May 2010 we evaluated 321 consecutive patients electively admitted to undergo total thyroidectomy for thyroid carcinoma. The first 201 patients (89 males, 112 females) presenting to our Department underwent thyroidectomy with the use of UAS while the following 120 patients (54 males, 66 females) underwent thyroidectomy performed with a conventional technique (CT): vessel clamp and tie. Results The operative time (mean: 75?min in UAS vs. 113?min in CT, range: 54 to 120?min in UAS vs. 68 to 173?min in CT) was much shorter in the group of thyroidectomies performed with UAS. The incidence of transient laryngeal nerve palsy (UAS 3/201 patients (1.49%); CT 1/120 patients (0.83%)) was higher in the group of UAS; the incidence of permanent laryngeal nerve palsy was similar in the two groups (UAS 2/201 patients (0.99%) vs. CT 2/120 patients (1.66%)). The incidence of transient hypocalcaemia (UAS 17/201 patients (8.4%) vs. CT 9/120 patients (7.5%)) was higher in the UAS group; no relevant differences were reported in the incidence of permanent hypocalcaemia in the two groups (UAS 5/201 patients (2.48%) vs. 2/120 patients (1.66%)). Also the average postoperative length of stay was similar in two groups (2?days). Conclusion The only significant advantage proved by this study is represented by the cost-effectiveness (reduction of the usage of operating room) for patients treated with UAS, secondary to the significant reduction of the operative time. The analysis failed to show any advantages in terms of postoperative transient complications in the group of patients treated with ultrasonic dissector: transient laryngeal nerve palsy (1.49% in UAS vs. 0.83% in CT) and transient hypocalcaemia (8.4% in UAS vs. 7.5%in CT). No significant differences in the incidence of permanent laryngeal nerve palsy (0.8% in UAS vs. 1.04% in CT) and permanent hypocalcaemia (2.6% in UAS vs. 2.04% in CT) were demonstrated. The level of surgeons’ expertise is a central factor, which can influence the complications rate; the use of UAS can only help surgical action but cannot replace the experience of the operator.
机译：背景我们对一组接受甲状腺癌甲状腺切除术的患者进行了一项观察性多中心临床研究。这项研究的目的是评估在接受甲状腺甲状腺癌手术的患者中使用超声解剖器（UAS）相对于使用常规技术（血管钳和扎带）的益处。方法从2009年6月至2010年5月，我们评估了321例经选择性入院接受甲状腺癌全甲状腺切除术的患者。到我科就诊的前201例患者（男89例，女性112例）使用UAS进行了甲状腺切除术，随后的120例患者（54例男性，66例女性）采用常规技术（CT）进行了甲状腺切除术：血管钳和扎带。结果在使用UAS进行的甲状腺切除术组中，手术时间（平均：UAS为75分钟，CT为113分钟，范围：UAS为54至120分钟，CT为68至173分钟）要短得多。 。在UAS组中，短暂性喉神经麻痹的发生率较高（UAS 3/201例（1.49％）; CT 1/120例（0.83％））。两组的永久性喉神经麻痹的发生率相似（UAS 2/201患者（0.99％）与CT 2/120患者（1.66％））。在UAS组中，短暂性低钙血症的发生率较高（UAS 17/201患者（8.4％）与CT 9/120患者（7.5％））。两组永久性低钙血症的发生率均未见相关差异（UAS 5/201患者（2.48％）对2/120患者（1.66％））。两组的平均术后住院时间相似（2天）。结论本研究证明的唯一显着优势是UAS治疗的成本效益（减少手术室使用），其次是手术时间的显着减少。在超声解剖器治疗的患者中，该分析未能显示出术后短暂并发症的任何优势：短暂性喉神经麻痹（UAS为1.49％，CT为0.83％）和短暂性低钙血症（UAS为8.4％，而7.5） ％in CT）。永久性喉神经麻痹的发生率（UAS为0.8％，CT为1.04％）和永久性低钙血症（UAS为2.6％，CT为2.04％）没有显着差异。外科医生的专业水平是一个中心因素，它会影响并发症发生率。使用UAS只能帮助进行外科手术，而不能代替操作者的经验。

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