[1]李进义* 王存川 胡友主 杨景哥 杨华.完全腔镜甲状腺手术大出血的处理及防治[J].中国微创外科杂志,2015,15(7):645-648.
　Li Jinyi,Wang Cunchuan,Hu Youzhu,et al.Treatment and Prevention of Massive Hemorrhage in Total Endoscopic Thyroidectomy[J].Chinese Journal of Minimally Invasive Surgery,2015,15(7):645-648.
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完全腔镜甲状腺手术大出血的处理及防治()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
15
期数:
2015年7期
页码:
645-648
栏目:
短篇论著
出版日期:
2015-07-20

文章信息/Info

Title:
Treatment and Prevention of Massive Hemorrhage in Total Endoscopic Thyroidectomy
作者:
李进义* 王存川 胡友主 杨景哥 杨华
（暨南大学附属第一医院普通外科暨南大学微创外科研究所，广州510630）
Author(s):
Li Jinyi;  Wang Cunchuan;  Hu Youzhu;  et al.
Department of General Surgery, First Affiliated Hospital of Jinan University, Jinan University Institute for Minimally Invasive Surgery, Guangzhou 510630, China
关键词:
腔镜/内镜; 甲状腺; 出血; 并发症
Keywords:
Laparoscopy/endoscopy; Thyroidectomy; Bleeding; Complication
分类号:
R653
文献标志码:
A
摘要:
目的探讨腔镜甲状腺手术大出血（出血量>300 ml）的出血规律及防治要点。方法回顾性分析2002年3月~2014年6月胸乳入路完全腔镜甲状腺手术3812例资料，共发生大出血9例（0.2%），术中出血5例（其中2例有“高气压后暂时不出血”现象），术后出血4例（术后3 h~9 d，其中2例为术后72 h后的迟发性出血）。出血量300~800 ml，平均4167 ml。结果9例均手术止血成功。术中出血1例中转开放手术，4例腔镜下止血；术后出血1例行开放手术，3例行腔镜手术。使用超声刀凝固、结扎缝扎套扎血管、切除渗血腺体、加压包扎等方法止血。出血部位为胸壁皮下隧道3例，颈前静脉1例，甲状腺血管3例，甲状腺腺体断面2例。无严重并发症及死亡。结论腔镜甲状腺手术大出血发生率不高，易于发现，可治可防，但其迟发性出血和“高气压后暂时不出血现象”应引起充分重视。
Abstract:
ObjectiveTo study the treatment and prevention of massive hemorrhage (bleeding volume >300 ml) in endoscopic thyroidectomy hemorrhage.MethodsA total of 3812 cases undergoing total endoscopic thyroidectomy via breast approach between March 2002 and June 2014 were reviewed retrospectively. Massive hemorrhage ocurred in 9 cases (0.2%), 5 of which were observed during operation (including 2 cases of "temporary not bleeding after high pressure" phenomenon) and 4 of which were observed postoperatively (3 h-9 d after operation, including 2 cases of delayed hemorrhage). The amount of bleeding was 300-800 ml, with an average of 416.7 ml. ResultsThe hemorrhage was stopped successfully in all the 9 cases. Of the 5 cases of intraoperative hemorrhage, endoscopy was completed in 4 cases and conversion to open surgery was required in 1. Of the 4 cases of postoperative hemorrhage, endoscopy was completed in 3 cases and open surgery was conducted in 1 case. Hemostatic methods included use of ultrasonic scalpel solidification, ligation of blood vessels, resection of the bleeding glands, and bandaging compression. The location of bleeding was in subcutaneous tunnel of chest wall in 3 cases, in anterior jugular vein in 1 case, in thyroid gland in 3 cases, and in thyroid gland section in 2 cases. No severe complications or death happened. ConclusionsThe incidence of hemorrhage in endoscopic thyroidectomy is low and easy to be observed, which can be treated and prevented. But the delayed hemorrhage and the phenomenon of "temporary not bleeding after high pressure" should be carefully observed.

参考文献/References:

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备注/Memo

备注/Memo:
*通讯作者，Email: tlijy@jnu.edu.cn
更新日期/Last Update: 2016-01-04