The Research Of Low Collar Mall Incision In Total Thyroidectomy And Neck Lymphnode Dissection

ObjectivesThe main objective: To explore the feasibility of Harmonic focus scalpel combinedwith automatic retractor auxiliary Low collar small incision underwent total thyroidectomyand selective neck lymphnode dissection; The secondary objective:1. Evaluate theapplication value of Harmonic focus scalpel and Frankfurt automatic retractor in opensurgery for thyroid cancer;2. Clear the suitable for incision length of low collar smallincision underwent total thyroidectomy and selective neck lymphnode dissection.Andtraditional surgical underwent total thyroidectomy and selective neck dissection.Methods1. Choice124thyroid cancer patients underwent total thyroidectomy and selectiveneck dissection thyroid in March2011-2012in September, the Jinan Military GeneralHospital, they were randomly divided into the experimental group of62patients and thecontrol group of62patients, The experimental groups adopt Harmonic focus scalpelcombined with automatic retractor auxiliary collar incision underwent total thyroidectomyand selective neck lymphnode dissection. The control groups adopt a high-frequencyelectric knife auxiliary low collar incision underwent total thyroidectomy, and selectiveneck lymphnode dissection;2. By the analysis method of t-test and χ2test (The number ofinformation theory of1≤T＜5adopt corrected χ2test, theoretical number of T <1adoptFisher’s exact test), two surgical pathologic data were statistically analyzed;3. Skinincision began to the suture of skin incision is completed for the surgery time;(suck outthe liquid volume–rinses)+(postoperative gauze weight–preoperative gauze weight)was intraoperative blood loss(1.05g=1ml); Beginning to place a drainage tube todrainage tube removed was the drainage time; within drainage time of total drainage ofliquid was total postoperative drainage volume; The postoperative parathyroid hormone, serum calcium, serum phosphorus values were the results obtained for the standard of thefirst postoperative day; Postoperative symptoms disappear within three months as atemporary nerve injury, postoperative symptoms without improved after3months or6months after the symptom still exists as a permanent nerve damage; Below15ng/L afterthe first day of parathyroid hormone whether appeared the symptoms was Temporaryparathyroid hormone injury;4. Two groups were compared for statistical analysis byhospitalization time, tumor size, incision length, operative time, blood loss, number ofsurgery, postoperative drainage, postoperative drainage time, preoperative andpostoperative parathyroid hormone、 serum calcium、serum phosphorusvalue, the numberof resected lymph nodes and postoperative complications. To explore the feasibility andpracticality of the technique.ResultsBoth the two surgical reached the surgical purposes and successfully completed.1. Surgical time (114.68±38.99min)of the experimental group was significantly lessthan the control group (204.18±24.91min),the difference between the two groups wasstatistically significant.2. Blood loss of experimental group(54.68±12.45mL) was significantly less thanthe control group(89.58±9.81mL), the difference between the two groups wasstatistically significant.3. Surgery the number of experimental group (2.00±0.00)was significantly less thanthe controlgroup(3.48±0.50), the difference between the two groups was statisticallysignificant.4. Incision lengths (4.88±0.54cm)of the experimental group was significantly lessthan the control group(7.09±0.75cm), the difference between the two groups wasstatistically significant.5. The two surgical hospital stay, tumor size, postoperative drainage, postoperativedrainage time, preoperative and postoperative parathyroid hormone、serum calcium、serum phosphorus value, the number of resected lymph nodes and Postoperativecomplications was not statistically significant.6. The two sets of surgical pathology data were compared, the difference was nostatistically significant.Conclusions1. The Harmonic focus ultrasonic scalpel shorten the operation time and reduced the amount of blood loss.2. Frankfurt automatic retractors can significantly reduced the operative number.3. Harmonic focus the ultrasonic scalpel joint Frankfurt the automatic retractorsauxiliary low collar small incision total thyroidectomy and selective neck dissection canshorten the surgical incision.4. The suitable for incision length of Harmonic focus scalpel adopting the low collarsmall incision surgery was4.5-5.5cm, the suitable for incision length of high-frequencyelectric knife conventional surgery was6.5-8cm.5. Compared with traditional surgery,Harmonic focus scalpel joint Frankfurt Autoretractor-assisted the the low collar small incision total thyroidectomy and selective necklymph node dissection can achieve the same surgery purpose and it had good cosmeticresults, Feasibility and practicality.