防粘膜在机器人甲状腺癌手术中的应用效果

钟玲; 张晔; 杜俊泽; 崔翔; 曾令娟; 张毅; 姜军; 范林军

doi:10.16016/j.1000-5404.202003162

您当前的位置：

首页 >

文章列表页 >

防粘膜在机器人甲状腺癌手术中的应用效果

临床医学 | 更新时间：2026-01-09

- 防粘膜在机器人甲状腺癌手术中的应用效果
- Application of anti-adhesion film in robotic thyroid cancer surgery alleviates postoperative soft tissue adhesion and swallowing discomfort
- 第三军医大学学报 2020年42卷第12期页码：1209-1214
- 作者机构：
  
  400038 重庆, 陆军军医大学(第三军医大学)第一附属医院乳腺甲状腺外科
- 作者简介：
  
  [范林军, E-mail:flj212@126.com FAN Linjun, E-mail:flj212@126.com
- 基金信息：
  
  重庆市技术创新与应用发展专项项目(CSCT2019jscx-msxmX0284)
- DOI：10.16016/j.1000-5404.202003162
  中图分类号： R181.32;R608;R736.1
- 收稿：2020-03-13，
  
  修回：2020-04-08，
  
  纸质出版：2020-06-30
- 稿件说明：
移动端阅览
钟玲, 张晔, 杜俊泽, 等. 防粘膜在机器人甲状腺癌手术中的应用效果[J]. 第三军医大学学报, 2020,42(12):1209-1214.

Ling ZHONG, Ye ZHANG, Junze DU, et al. Application of anti-adhesion film in robotic thyroid cancer surgery alleviates postoperative soft tissue adhesion and swallowing discomfort[J]. Journal of Third Military Medical University, 2020, 42(12): 1209-1214.
钟玲, 张晔, 杜俊泽, 等. 防粘膜在机器人甲状腺癌手术中的应用效果[J]. 第三军医大学学报, 2020,42(12):1209-1214. DOI： 10.16016/j.1000-5404.202003162.

Ling ZHONG, Ye ZHANG, Junze DU, et al. Application of anti-adhesion film in robotic thyroid cancer surgery alleviates postoperative soft tissue adhesion and swallowing discomfort[J]. Journal of Third Military Medical University, 2020, 42(12): 1209-1214. DOI： 10.16016/j.1000-5404.202003162.

摘要

目的

探讨防粘膜在机器人甲状腺癌手术中的防粘连效果。

方法

回顾性分析本院2016年1月至2018年12月接受达芬奇机器人甲状腺癌手术患者452例的临床资料及治疗效果

其中试验组228例在完成甲状腺切除以及淋巴结清扫后将防粘膜(可吸收医用膜)放置在气管前方后缝合颈白线。对照组224例除未使用防粘膜外其他操作与试验组相同。

结果

试验组吞咽不适状况评分在术后3、6个月均明显低于对照组。亚组分析结果显示

单侧甲状腺切除患者术后3、6、12个月其吞咽不适的评分两组间差异均无统计学意义(

0.05)。甲状腺全切患者试验组与对照组的吞咽不适评分在术后3个月(

=0.00)、6个月(

=0.001)均明显低于对照组; 试验组与对照组吞咽不适发生率(轻度+较重)在术后3个月(

=0.004)、6个月(

=0.006)差异均有统计学意义

使用防粘膜后吞咽不适发生率均明显低于对照组。两组术后声音嘶哑和甲状旁腺功能减退发生率、引流量以及住院时间等方面差异均无统计学意义(

0.05)。

结论

机器人甲状腺全切患者术中使用可吸收医用膜能有效减轻颈部软组织粘连

改善术后吞咽不适

提高患者术后生活质量。

Abstract

Objective

To investigate the anti-adhesion effect of anti-adhesion film in robotic thyroid cancer surgery.

Methods

We retrospectively analyzed the clinical data and treatment outcomes of 452 patients who underwent Da Vinci robotic surgery for thyroid cancer between January

2016 and December

2018.In 228 of the patients

anti-adhesion film (absorbable medical film) was placed on the trachea before thyroid resection and dissection of the lymph nodes (test group); the other 224 patients underwent identical surgical procedures but without the use of the anti-adhesion film (control group).

Results

The scores for swallowing discomfort were significantly lower in the test group than in the control group at 3 and 6 months after the operation.Subgroup analysis showed that in the patients receiving unilateral thyroidectomy

the scores for swallowing discomfort did not differ significantly between the 2 groups at 3

and 12 months postoperatively.In patients receiving total thyroidectomy

the scores

were significantly lower in the test group than in the control group at 3 months (

=0.00) and 6 months (

=0.001)

and the incidence of swallowing discomfort (either mild or severe) was also significantly lower in the test group at 3 months (74.6% vs 83.6%

=0.004) and 6 months (24.2% vs 40.9%

=0.006) after the operation.No significant differences were found in the incidences of postoperative hoarseness and hypoparathyroidism

drainage volume

or the length of hospital stay between the 2 groups.

Conclusion

The use of absorbable medical film during robotic total thyroidectomy for thyroid cancer can effectively reduce neck soft tissue adhesion

lower the incidence of postoperative swallowing discomfort

and improve postoperative quality of life of the patients.

关键词

Keywords

references

KREKELER B N, WENDT E, MACDONALD C, et al . Patient-reported dysphagia after thyroidectomy: a qualitative study[J ] . Otolaryngol Head Neck Surg, 2018, 144(4): 342-348. DOI: 10.1001/jamaoto.2017.3378.

LOMBARDI C P, RAFFAELLI M, D'ALATRI L, et al . Voice and swallowing changes after thyroidectomy in patients without inferior laryngeal nerve injuries[J ] . Surgery, 2006, 140(6): 1026-1032; discussion 1032-4. DOI: 10.1016/j.surg.2006.08.008.

PEREIRA J A, GIRVENT M, SANCHO J J, et al . Prevalence of long-term upper aerodigestive symptoms after uncomplicated bilateral thyroidectomy[J ] . Surgery, 2003, 133(3): 318-322. DOI: 10.1067/msy.2003.58.

PARK W S, CHUNG Y S, LEE K E, et al . Anti-adhesive effect and safety of sodium hyaluronate and sodium carboxymethyl cellulose solution in thyroid surgery[J ] . Asian J Surg, 2010, 33(1): 25-30. DOI: 10.1016/S1015-9584(10)60005-X.

丁纪伟, 汤治平, 禤杏华, 等.医用生物膜在腔镜甲状腺手术中预防颈前皮瓣粘连的应用[J].岭南现代临床外科, 2012, 12(1): 45-46, 53.

DING J W, TANG Z P, XUAN X H, et al . Application of medical biological membrane on preventing from anterior cervical skin flap adhesion in endoscopic thyroid surgery[J ] . Lingnan Mod Clin Surg, 2012, 12(1): 45-46, 53.

LIU P F, ZHANG Y, QI X W, et al . Unilateral axilla-bilateral areola approach for thyroidectomy by Da vinci robot: 500 cases treated by the same surgeon[J ] . J Cancer, 2019, 10(16): 3851-3859. DOI: 10.7150/jca.31463.

LOMBARDI C P, RAFFAELLI M, D'ALATRI L, et al . Video-assisted thyroidectomy significantly reduces the risk of early postthyroidectomy voice and swallowing symptoms[J ] . World J Surg, 2008, 32(5): 693-700. DOI: 10.1007/s00268-007- 9443-2.

ERTEKIN C, AYDOGDU I. Neurophysiology of swallowing[J]. Clin Neurophysiol, 2003, 114(12): 2226-2244. DOI: 10.1016/s1388-2457(03) 00237-2.

杨玉峰, 刘萍, 曲国红, 等.防粘连膜减轻甲状腺术后皮下瘢痕47例分析[J].中国现代普通外科进展, 2012, 15(4): 318-319.

YANG Y F, LIU P, QU G H, et al . Analysis of 47 cases of anti-adhesive film to reduce subcutaneous scar after thyroid surgery [J ] . Chin J Curr Adv Gen Surg, 2012, 15(4): 318-319.

PARK K S, LEE K E, KU D O H, et al . Antiadhesive effect and safety of oxidized regenerated cellulose after thyroidectomy: a prospective, randomized controlled study[J ] . J Korean Surg Soc, 2013, 84(6): 321-329. DOI: 10.4174/jkss. 2013.84.6.321.

CHO J G, BYEON H K, OH K H, et al . Objective assessment of postoperative swallowing difficulty through ultrasound in patients undergoing thyroidectomy[J ] . Dysphagia, 2020, 25 (2): 253-260. DOI: 10.1007/s00455-019- 10020-1.

BAE D S, WOO J W, PAEK S H, et al . Antiadhesive effect and safety of sodium hyaluronate-carboxymethyl cellulose membrane in thyroid surgery[J ] . J Korean Surg Soc, 2013, 85(5): 199-204. DOI: 10.4174/jkss.2013. 85.5.199.

ZENG Q Q, YU Z P, YOU J, et al . Efficacy and safety of Seprafilm for preventing postoperative abdominal adhesion: systematic review and meta-analysis[J ] . World J Surg, 2007, 31(11): 2125-2131; discussion 2132. DOI: 10.1007/s00268-007-9242-9.

沈伟敏, 封光华, 贾忠.医用生物膜在颈部手术中的应用[J].医学研究杂志, 2006, 35(11): 98-99.

SHEN W M, FENG G H, JIA Z. Application of medical biofilm in neck surgery [J]. J Med Res, 2006, 35(11): 98-99.

LI R Y, LIU Z G, LIU H Q, et al . Evaluation of biocompatibility and toxicity of biodegradable poly (DL-lactic acid) films[J ] . Am J Transl Res, 2015, 7(8): 1357-1370.

庞秀炳, 潘永明, 华菲, 等.聚乳酸/乙醇酸可吸收医用膜对兔腹腔术后粘连的预防作用研究[J].中国医疗器械杂志, 2014, 38(5): 389-392.

PANG X B, PAN Y M, HUA F, et al . Effects of PLGA absorbable membrane on preventing postoperative abdominal adhesion in rabbits[J ] . Chin J Med Instrum, 2014, 38(5): 389-392.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

¹⁸F-FDG PET/CT探测早期甲状腺癌1例