| Objective:This paper mainly discusses the comparison of different types of surgical energy instruments used in open thyroid surgery to provide a reference for better selection of surgical energy instruments.On the one hand,it can reduce postoperative complications of parathyroid dysfunction and hypocalcemia;on the other hand,it can shorten the operation time,reduce intraoperative blood loss,postoperative drainage and hospital stay,so as to determine which energy instrument is more conducive to open thyroid surgery.Methods:The clinical and laboratory data of 120 patients with total thyroidectomy who were eligible for thyroid tumor disease and treated with different energy instruments from November 2020 to September 2021 in the Department of Thyroidectomy,Affiliated Hospital of Qinghai University were collected,and the diseases affecting calcium and phosphorus metabolism in the body,the insufficiency of important organs and the cases of secondary operation were excluded.The patients were divided into three groups according to the different use of energy instruments.Forty patients in each group underwent thyroid surgery were selected and their basic data were analyzed:age,sex,BMI,etc.Intraoperative data:type of surgical instruments,operation time,preoperative and postoperative test results:preoperative serum PTH concentration,serum calcium,phosphorus and magnesium ion concentration,serum PTH concentration,serum calcium,phosphorus and magnesium ion concentration on the 1st postoperative day,postoperative drainage volume on the 1st postoperative day,postoperative hospital stay,etc.Statistical methods SPSS26.0 software package was used for statistical analysis of the data.The measurement data consistent with normal distribution and homogeneity of variance were expressed as mean±standard deviation.T-test was used for comparison between the two,analysis of variance was used for comparison between the three,and SNK test was used for further analysis.T’test was used for measurement data with uneven variance of counting data.χ~2test was used for counting data conforming to bidirectional disorder.Non-normally distributed data were represented by median and quartile,and rank sum test was used for all data.P<0.05was considered statistically significant.To compare the postoperative parathyroid function of patients with bilateral total thyroidectomy using three different energy instruments,observe that the use of energy instruments is more conducive to reduce the occurrence of postoperative hypocalcemia.Results:A total of 120 patients with total thyroidectomy were collected according to strict inclusion criteria,and 40 patients in each of the three groups were treated with different energy instruments.The incidence of postoperative overall hypoparathyroidism was 16.7%and hypocalcemia was 25.5%.In the high-frequency electric knife group,there were 4 males and 36 females,with an average age of51.8±10.99 years and an average body mass index of 24.00±2.95.The incidence of postoperative hypoparathyroidism was 27.5%and hypocalcemia was 42.5%.In the harmonic scalpel group,there were 4 males and 36 females.The mean age was47.90±10.34 years,and the mean body mass index was 24.84±3.16.The incidence of postoperative hypoparathyroidism was 12.5%and hypocalcemia was 25%.There were8 males and 32 females in the harmonic scalpel combined with bipolar electrocoagulation forceps group,with an average age of 49.10±7.75 years,and an average body mass index of 24.84±3.18 years.The incidence of postoperative parathyroidism was 10%and hypocalcemia was 10%.The preoperative data of the three groups(gender,age,BMI,blood PTH,blood calcium,phosphorus and magnesium)were analyzed and showed P>0.05,while there was no significant difference in preoperative general data.Analysis of postoperative test data(blood PTH,blood calcium,phosphorus,magnesium)showed that the comparison of serum PTH and serum calcium of the three groups showed P<0.05.Further pairwise comparison showed that the PTH and blood calcium of the harmonic scalpel group and harmonic scalpel combined with bipolar electrocoagulation forceps group were superior to that of the high-frequency electric knife group.There was no significant difference in blood phosphorus and magnesium ions(P>0.05).Analysis of postoperative data(operative time,intraoperative blood loss,postoperative drainage volume,postoperative length of hospital stay)showed that the comparison of operative time showed P<0.05,the time consumption of high-frequency electric knife group and harmonic scalpel combined with bipolar electrocoagulation forceps group was higher than that of harmonic scalpel group.In terms of intraoperative blood loss,P<0.05,the harmonic scalpel combined with bipolar electrocoagulation forceps group was superior to the harmonic scalpel group and the high-frequency electric knife group.In terms of postoperative drainage reduction,P<0.05,there was no significant difference between the harmonic scalpel group and the harmonic scalpel combined with bipolar electrocoagulation forceps group,but they were better than the high-frequency electric knife group.However,there was no significant difference in postoperative hospital stay(P>0.05).Conclusion:In thyroid surgery,harmonic scalpel or combined with bipolar electrocoagulation forceps can significantly reduce the incidence of postoperative hypoparathyroidism and hypocalcemia,and effectively reduce postoperative drainage.At the same time,combined use can reduce the amount of intraoperative blood loss,and is more suitable for thyroid surgery.There was no significant difference between the three groups in postoperative elevation of blood phosphorus,hyperphosphatemia or reduction of magnesium ion.The use of harmonic scalpel was associated with shorter operative time and the lowest incidence of hypomagnesemia.There was no significant difference in postoperative hospital stay among the three groups. |
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