经腋窝入路腔镜甲状腺手术拉钩的制作及应用

doi:10.3761/j.issn.0254-1769.2023.12.018

摘要/Abstract

摘要：

目的制作一种经腋窝入路腔镜甲状腺手术拉钩应用于腔镜甲状腺手术，并探讨其应用效果。方法设计一种经腋窝入路腔镜甲状腺手术拉钩。采用方便抽样方法，将2020年1月—2022年5月在徐州市中心医院就诊的80例单侧甲状腺癌的手术患者作为应用对象，根据手术选用显露术野的拉钩不同，将手术患者分为试验组和对照组，试验组采用经腋窝入路腔镜甲状腺手术拉钩显露术野，对照组采用常规腔镜拉钩显露术野。比较两组的临床指标、喉返神经损伤发生率及美容效果评分。结果试验组手术时间及喉返神经显露时间比对照组短，差异有统计学意义（t=-2.647，-12.554，P<0.05）；两组喉返神经损伤发生例数比较，差异有统计学意义（χ²=4.507，P<0.05）；两组术后1个月美容效果评分比较，差异有统计学意义（t=-8.635，P<0.001）。结论该研究制作的经腋窝入路腔镜甲状腺手术拉钩可充分暴露手术视野，可缩短手术时间，减少喉返神经损伤的发生，另外拉钩的球拍型设计可缩小手术切口，增加美容效果。

关键词: 甲状腺拉钩, 空间暴露, 喉返神经, 护理

Abstract:

Objective To develop a novel retractor for transaxillary endoscopic thyroid surgery and to explore its clinical application effect. Methods A retractor device for transaxillary endoscopic thyroid surgery was designed and developed，and we performed a retrospective study with random sampling design. A total of 80 thyroid cancer patients undergoing transaxillary endoscopic unilateral thyroidectomy in Xuzhou Central Hospital from January 2020 to May 2022 were selected as the research subjects. According to the type of the retractor used to expose the surgical field during surgery，the patients were divided into a control group and a test group，with 40 patients in each group. The patients in the control group underwent surgery with conventional retractor，while patients in the test group underwent surgery with the novel retractor device. The clinical indicators，incidence of recurrent laryngeal nerve injury and cosmetic score were recorded and compared between the 2 groups. Results The surgery time and recurrent laryngeal nerve exposure time were significant shorter in the test group（t=-2.647，-12.554，P<0.05）. Besides，the occurrence of recurrent laryngeal nerve injury in the test group were significant less than that in the control group（χ²=4.507，P<0.05）. Furthermore，the cosmetic score at 1-month post-surgery in the test group was higher than that in the control group，with statistical significance（t=-8.635，P<0.001）. Conclusion The full exposure of the new endoscopic thyroid retractor can shorten the operation time and reduce the chance of recurrent laryngeal nerve injury. In addition，the racquet design of the retractor can narrow the surgical incision and increase the cosmetic effect.

Key words: Novel Endoscopic Thyroid Retractor, Space Exposure, Recurrent Laryngeal Nerve, Nursing Care

王明玲, 陈志兰, 曹新颖, 王凯, 陈保云, 贾高磊. 经腋窝入路腔镜甲状腺手术拉钩的制作及应用[J]. 中华护理杂志, 2023, 58(12): 1529-1532.

WANG Ming-ling, CHEN Zhilan, CAO Xinying, WANG Kai, CHEN Baoyun, JIA Gaolei. Development and application of a novel retractor for transaxillary endoscopic thyroid surgery[J]. Chinese Journal of Nursing, 2023, 58(12): 1529-1532.

图/表 5

图1 新型腔镜甲状腺拉钩注：1.第1拉钩；2.第2拉钩；3.剥离部；4.镂空；5.拉钩部；6.吸引管；7.主拉钩；8.固定部；9.挂孔。

Figure 1 The novel endoscopic thyroid retractor

图2 术中各个切口位置及新型腔镜甲状腺拉钩的放置方法

Figure 2 Position of each incision and placement of endoscopic thyroid retractor during surgery

表1 两组一般资料的比较

Table 1 Comparison of general data of patients in 2 groups

表2 两组临床指标比较结果（$\bar{x}\pm s$）

Table 2 Comparison results of clinical indicators between 2 groups（$\bar{x}\pm s$）

表3 两组术后喉返神经损伤发生例数及术后1个月美容效果评分结果比较

Table 3 Comparison results of the number of the patients occurred recurrent laryngeal nerve injury and the cosmetic score at 1-month post-surgery between 2 groups

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