[1]贾高磊 田志龙 耿厚法① 耿浩 高新宝**.无充气腋窝入路完全腔镜下甲状腺手术意外出血的处理[J].中国微创外科杂志,2022,01(7):570-574.
　Jia Gaolei*,Tian Zhilong*,Geng Houfa,et al.Treatment of Accident Hemorrhage in Endoscopic Thyroidectomy Using the Gasless Unilateral Axillary Approach[J].Chinese Journal of Minimally Invasive Surgery,2022,01(7):570-574.
点击复制

无充气腋窝入路完全腔镜下甲状腺手术意外出血的处理()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2022年7期
页码:
570-574
栏目:
短篇论著
出版日期:
2022-10-09

文章信息/Info

Title:
Treatment of Accident Hemorrhage in Endoscopic Thyroidectomy Using the Gasless Unilateral Axillary Approach
作者:
贾高磊 田志龙 耿厚法① 耿浩 高新宝**
(江苏省徐州市中心医院血管、甲状腺和疝外科，徐州221009)
Author(s):
Jia Gaolei*;  Tian Zhilong*;  Geng Houfa;  et al.
*Department of Vascular, Thyroid and Hernia Surgery, Xuzhou Central Hospital, Xuzhou 221009, China
关键词:
甲状腺; 腔镜; 出血; 并发症
Keywords:
Thyroid gland; Endoscopy; Hemorrhage; Complication
文献标志码:
A
摘要:
目的探讨无充气腋窝入路全腔镜甲状腺手术意外出血的处理方法和特点。方法回顾性分析2019年10月~2021年10月无充气经腋窝入路全腔镜甲状腺手术110例资料，共发生意外出血9例(8.2%)。术中出血8例，出血量35~100 ml，使用超声刀凝固、血管夹或生物蛋白夹夹闭；术后出血1例，为胸壁血肿，出血量1440 ml，加压包扎及对症处理。结果9例均止血成功，无中转开放手术，无非计划再次手术。术中出血的血管为甲状腺下动脉分支1例，甲状腺最下动脉1例，颈外静脉属支2例，颈内静脉属支3例，颈前静脉1例；胸壁血肿1例为胸壁穿支血管出血。结论对于无充气腋窝入路全腔镜甲状腺手术意外出血，术中出血可及时采取凝闭、夹闭等措施妥善处理，术后出血不易引起气管压迫、窒息，可从容处理。
Abstract:
ObjectiveTo study the treatment and characteristics of accident hemorrhage in endoscopic thyroidectomy using the gasless unilateral axillary approach.MethodsA total of 110 cases undergoing endoscopic thyroidectomy using the gasless unilateral axillary approach between October 2019 and October 2021 were reviewed retrospectively. Accident hemorrhage occurred in 9 cases (8.2%). Eight of them were found during the operation. The amount of bleeding was 35-100 ml. The hemostatic therapy was completed by using ultrasonic scalpel solidification, vascular clamping and biological protein clamping. Postoperative hemorrhage occurred in 1 case, which was a chest wall hematoma with a bleeding volume of 1440 ml. Pressure bandage and symptomatic treatment were performed.ResultsThe hemorrhage was stopped successfully in all the 9 cases. No conversion to open surgery or unplanned reoperation was required. The location of bleeding was in the inferior thyroid artery branch in 1 case, arteria thyroidea ima in 1 case, vena jugularis externa branch in 2 cases, jugular vein branch in 3 cases, and anterior jugular vein in 1 case. One case of chest wall hematoma was bleeding from perforating vessels of chest wall.ConclusionsFor the accident hemorrhage in endoscopic thyroidectomy using the gasless unilateral axillary approach, measures such as coagulation and clamping can be taken in time to properly deal with the intraoperative bleeding. The postoperative bleeding is not prone to tracheal compression and asphyxia, which can be handled steady.

参考文献/References:

[1]仇明.内镜甲状腺手术意外出血常见原因及防治对策.中国实用外科杂志,2007,27(9):690-691.
[2]郑传铭，徐加杰，蒋烈浩，等.无充气腋窝入路完全腔镜下甲状腺叶切除的方法——葛-郑氏七步法.中国普通外科杂志,2019,28(11):1336-1441.
[3]中华医学会超声医学分会浅表器官和血管学组,中国甲状腺与乳腺超声人工智能联盟.2020甲状腺结节超声恶性危险分层中国指南：CTIRADS.中华超声影像学杂志,2021,30(3):185-200.
[4]医学名词审定委员会显微外科学名词审定分委员会.显微外科学名词.北京：科学出版社，2016.32-33.
[5]杨卫平，邵堂雷．甲状腺手术后出血预防和处理．中国实用外科杂志，2012，32(5)：377-379.
[6]李进义，王存川，胡友主，等.完全腔镜甲状腺手术大出血的处理及防治.中国微创外科杂志，2015，15(7)：645-646.

备注/Memo

备注/Memo:
基金项目：江苏省科教强卫青年医学人才重点项目(QNRC2016388)；江苏省人力资源和社会保障厅博士后专项基金(［2017］第279号)**通讯作者，Email：499581400@qq.com ①内分泌科
更新日期/Last Update: 2022-10-09