Analysis on the superiority of bipolar coagulation forceps combined with meticulous capsular dissection technique in thyroidectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Dejie , LIN Guoliang , ZHANG Ming , YANG Xianrong , ZHANG Ditian , LIAO Mingxing ,  WANG Qicai

Department of The Third General Surgery, Longyan First Hospital, Fujian Medical University, Longyan, Fujian 364000, P.R.China;

Corresponding?author：

WANG Qicai, Email: wangqc88@163.com

Keywords：

bipolar coagulation forceps; meticulous capsular dissection technique; thyroidectomy

DOI：

10.7507/1007-9424.201607055

Video：

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Objective To investigate the value of bipolar coagulation forceps combined with meticulous capsular dissection technique in thyroidectomy. Methods Information of 203 patients with thyroid neoplasms who underwent thyroidectomy in Longyan First Hospital from January 2014 to July 2015, were collected retrospectively. Patients were divide into control group (98 patients who had received conventional thyroidectomy) and observation group (105 patients who had received bipolar coagulation forceps combined with meticulous capsular dissection technique in thyroidectomy) according to the surgery type. Then comparison of 2 groups in incidence of recurrent laryngeal nerve injury, temporary hypocalcemia, temporary or permanent hypoparathyroidism, serum parathyroid hormone (PTH) and serum calcium was performed. Results All the operation of 203 patients went smoothly, and no operative death happened. Operation time of control group and observation group showed no obvious difference〔(68.24±16.59) minvs. (64.78±14.20) min,P>0.05〕, but the intraoperative blood loss of control group was more than observation group〔(25.44±8.35) mLvs. (16.58±5.44) mL,P<0.05〕. There were 25 patients suffered from temporary hypocalcemia after operation, including 18 patients in control group and 7 patients in observation group. There were 38 patients suffered from temporary hypoparathyroidism after operation. including 24 patients in control group and 14 patients in observation group. The incidences of temporary hypocalcemia (χ²=6.426,P<0.05) and temporary hypoparathyroidism (χ²=4.147,P<0.05) were both lower in observation group than corresponding index of control group. But no one suffered from permanent hypoparathyroidism. There were 17 patients existent hoarseness in the control group and 14 patients in observation group, but no one had cough caused by superior laryngeal nerve injury of all the patients, and the incidence of hoarseness of 2 groups had no significant difference (χ²=0.637,P>0.05). Conclusions Bipolar coagulation forceps combined with meticulous capsular dissection technique in thyroidectomy could reduce the temporary hypocalcemia and temporary hypoparathyroidism, and provide the better protection to the blood supply of parathyroid. In addition, bipolar coagulation forceps could reduce thermal injury and heighten hemostasis. So, it is worthy to perform bipolar coagulation forceps combined with meticulous capsular dissection technique in thyroidectomy.

Citation： ZHANG Dejie, LIN Guoliang, ZHANG Ming, YANG Xianrong, ZHANG Ditian, LIAO Mingxing, WANG Qicai. Analysis on the superiority of bipolar coagulation forceps combined with meticulous capsular dissection technique in thyroidectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(3): 322-327. doi: 10.7507/1007-9424.201607055 Copy

1.	?Giordano D, Valcavi R, Thompson GB,et al. Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1 087 patients and review of the literature. Thyroid, 2012, 22(9): 911-917.
2.	Hayward NJ, Grodski S, Yeung M,et al. Recurrent laryngeal nerve injury in thyroid surgery: a review. ANZ J Surg, 2013, 83(1-2): 15-21.
3.	宋斌. 甲狀腺被膜內次全切除術與被膜外次全切除術的近期并發癥比較. 實用臨床醫藥雜志, 2013, 17(16): 36-38.
4.	Vassiliou I, Tympa A, Arkadopoulos N,et al. Total thyroidectomy as the single surgical option for benign and malignant thyroid disease: a surgical challenge. Arch Med Sci, 2013, 9(1): 74-78.
5.	秦堅, 徐曉波, 周致圓, 等. 甲狀腺手術方式和喉返神經損傷的關系. 中國普外基礎與臨床雜志, 2014, 21(9): 1149-1151.
6.	Tomoda C, Hirokawa Y, Uruno T,et al. Sensitivity and specificity of intraoperative recurrent laryngeal nerve stimulation test for predicting vocal cord palsy after thyroid surgery. World J Surg, 2006, 30(7): 1230-1233.
7.	Haugen BR, Alexander EK, Bible KC,et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid, 2016, 26(1): 1-133.
8.	NCCN. NCCN clinical practice guidelines in oncology. Thyroid carcinoma. Version 1. 2011. .
9.	中華醫學會內分泌學分會, 中華醫學會外科學分會, 中國抗癌協會頭頸腫瘤專業委員會, 等. 甲狀腺結節和分化型甲狀腺癌診治指南. 中國腫瘤臨床, 2012, 39(17): 1249-1272.
10.	中國醫師協會外科醫師分會甲狀腺外科醫師委員會. 甲狀腺及甲狀旁腺手術中神經電生理監測臨床指南(中國版). 中國實用外科雜志, 2013, 33(6): 470-474.
11.	王卓穎, 孫團起, 吳毅, 等. 中央區淋巴結清掃在甲狀腺乳頭狀微小癌治療中的意義(附 10 年 1 048 例報告). 中國實用外科雜志, 2014, 34(1): 93-96.
12.	中國醫師協會外科醫師分會甲狀腺外科醫師委員會. 甲狀腺手術中甲狀旁腺保護專家共識. 中國實用外科雜志, 2015, 35(7): 731-736.
13.	周龍翔, 俞冬, 徐軍, 等. 采用精細化被膜解剖+喉返神經顯露法行甲狀腺腺葉切除 452 例臨床分析. 中國普外基礎與臨床雜志, 2013, 20(6): 638-642.
14.	Bliss RD, Gauger PG, Delbridge LW. Surgeon’s approach to the thyroid gland: surgical anatomy and importance of technique. World J Surg, 2000, 24(8): 891-897.
15.	楊海瑞, 董慶申. 精細被膜解剖法在甲狀腺手術中預防喉返神經與甲狀旁腺損傷的應用. 中國微創外科雜志, 2014, 14(9): 802-804.
16.	Gil Z, Patel SG. 甲狀腺癌手術——Memorial Sloan-Kettering Cancer Center經驗(一). 中華耳鼻咽喉頭頸外科雜志, 2011, 46(9): 787-791.
17.	梁健文, 張有利, 楊小靜, 等. 甲狀腺癌全切術中應用被膜解剖技術對甲狀旁腺功能及喉返神經的影響. 河南醫學研究, 2016, 25(2): 237-239.
18.	Ahmed M, Aurangzeb, Abbas S,et al. Should we routinely expose recurrent laryngeal nerve(s) during thyroid surgery? J Coll Physicians Surg Pak, 2013, 23(3): 186-189.
19.	Ellis H. Anatomy of the thyroid and parathyroid glands. Surgery, 2007, 25(11): 467-468.
20.	朱思翔. 鼻內鏡下雙極電凝與微波治療老年難治性鼻出血的臨床療效. 中國老年學雜志, 2016, 36(15): 3776-3778.
21.	鄧偉光, 郭曉蘭, 杜紅. 超聲刀聯合高頻雙極電凝對甲狀腺癌患者喉返神經及甲狀旁腺的影響. 蚌埠醫學院學報, 2016, 41(7): 917-919.
22.	Bulsara KR, Sukhla S, Nimjee SM. History of bipolar coagulation. Neurosurg Rev, 2006, 29(2): 93-96.
23.	邱堃, 王一森, 吳元清. 雙極電凝系統與超聲刀在甲狀腺手術中應用效果觀察. 中華普外科手術學雜志(電子版), 2015, 9(6): 47-49.
24.	李加涌, 桑劍鋒, 姚永忠, 等. 雙極電凝鑷在開放性甲狀腺手術中的臨床應用. 中國普外基礎與臨床雜志, 2016, 23(1): 75-78.
25.	魏濤, 朱精強. 甲狀腺手術理念進展與新型手術器械在甲狀腺外科中的應用. 中國普外基礎與臨床雜志, 2011, 18(2): 220-224.
26.	李衛民, 王芳, 王艷明, 等. LigaSure 與雙極電刀在腹腔鏡巨大子宮切除術中的聯合應用. 腹腔鏡外科雜志, 2015, 20(12): 896-898.

1. ?Giordano D, Valcavi R, Thompson GB,et al. Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1 087 patients and review of the literature. Thyroid, 2012, 22(9): 911-917.
2. Hayward NJ, Grodski S, Yeung M,et al. Recurrent laryngeal nerve injury in thyroid surgery: a review. ANZ J Surg, 2013, 83(1-2): 15-21.
3. 宋斌. 甲狀腺被膜內次全切除術與被膜外次全切除術的近期并發癥比較. 實用臨床醫藥雜志, 2013, 17(16): 36-38.
4. Vassiliou I, Tympa A, Arkadopoulos N,et al. Total thyroidectomy as the single surgical option for benign and malignant thyroid disease: a surgical challenge. Arch Med Sci, 2013, 9(1): 74-78.
5. 秦堅, 徐曉波, 周致圓, 等. 甲狀腺手術方式和喉返神經損傷的關系. 中國普外基礎與臨床雜志, 2014, 21(9): 1149-1151.
6. Tomoda C, Hirokawa Y, Uruno T,et al. Sensitivity and specificity of intraoperative recurrent laryngeal nerve stimulation test for predicting vocal cord palsy after thyroid surgery. World J Surg, 2006, 30(7): 1230-1233.
7. Haugen BR, Alexander EK, Bible KC,et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid, 2016, 26(1): 1-133.
8. NCCN. NCCN clinical practice guidelines in oncology. Thyroid carcinoma. Version 1. 2011. .
9. 中華醫學會內分泌學分會, 中華醫學會外科學分會, 中國抗癌協會頭頸腫瘤專業委員會, 等. 甲狀腺結節和分化型甲狀腺癌診治指南. 中國腫瘤臨床, 2012, 39(17): 1249-1272.
10. 中國醫師協會外科醫師分會甲狀腺外科醫師委員會. 甲狀腺及甲狀旁腺手術中神經電生理監測臨床指南(中國版). 中國實用外科雜志, 2013, 33(6): 470-474.
11. 王卓穎, 孫團起, 吳毅, 等. 中央區淋巴結清掃在甲狀腺乳頭狀微小癌治療中的意義(附 10 年 1 048 例報告). 中國實用外科雜志, 2014, 34(1): 93-96.
12. 中國醫師協會外科醫師分會甲狀腺外科醫師委員會. 甲狀腺手術中甲狀旁腺保護專家共識. 中國實用外科雜志, 2015, 35(7): 731-736.
13. 周龍翔, 俞冬, 徐軍, 等. 采用精細化被膜解剖+喉返神經顯露法行甲狀腺腺葉切除 452 例臨床分析. 中國普外基礎與臨床雜志, 2013, 20(6): 638-642.
14. Bliss RD, Gauger PG, Delbridge LW. Surgeon’s approach to the thyroid gland: surgical anatomy and importance of technique. World J Surg, 2000, 24(8): 891-897.
15. 楊海瑞, 董慶申. 精細被膜解剖法在甲狀腺手術中預防喉返神經與甲狀旁腺損傷的應用. 中國微創外科雜志, 2014, 14(9): 802-804.
16. Gil Z, Patel SG. 甲狀腺癌手術——Memorial Sloan-Kettering Cancer Center經驗(一). 中華耳鼻咽喉頭頸外科雜志, 2011, 46(9): 787-791.
17. 梁健文, 張有利, 楊小靜, 等. 甲狀腺癌全切術中應用被膜解剖技術對甲狀旁腺功能及喉返神經的影響. 河南醫學研究, 2016, 25(2): 237-239.
18. Ahmed M, Aurangzeb, Abbas S,et al. Should we routinely expose recurrent laryngeal nerve(s) during thyroid surgery? J Coll Physicians Surg Pak, 2013, 23(3): 186-189.
19. Ellis H. Anatomy of the thyroid and parathyroid glands. Surgery, 2007, 25(11): 467-468.
20. 朱思翔. 鼻內鏡下雙極電凝與微波治療老年難治性鼻出血的臨床療效. 中國老年學雜志, 2016, 36(15): 3776-3778.
21. 鄧偉光, 郭曉蘭, 杜紅. 超聲刀聯合高頻雙極電凝對甲狀腺癌患者喉返神經及甲狀旁腺的影響. 蚌埠醫學院學報, 2016, 41(7): 917-919.
22. Bulsara KR, Sukhla S, Nimjee SM. History of bipolar coagulation. Neurosurg Rev, 2006, 29(2): 93-96.
23. 邱堃, 王一森, 吳元清. 雙極電凝系統與超聲刀在甲狀腺手術中應用效果觀察. 中華普外科手術學雜志(電子版), 2015, 9(6): 47-49.
24. 李加涌, 桑劍鋒, 姚永忠, 等. 雙極電凝鑷在開放性甲狀腺手術中的臨床應用. 中國普外基礎與臨床雜志, 2016, 23(1): 75-78.
25. 魏濤, 朱精強. 甲狀腺手術理念進展與新型手術器械在甲狀腺外科中的應用. 中國普外基礎與臨床雜志, 2011, 18(2): 220-224.
26. 李衛民, 王芳, 王艷明, 等. LigaSure 與雙極電刀在腹腔鏡巨大子宮切除術中的聯合應用. 腹腔鏡外科雜志, 2015, 20(12): 896-898.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis on the superiority of bipolar coagulation forceps combined with meticulous capsular dissection technique in thyroidectomy

Abstract Full text Figures/Tables Video References Cited by

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