关键词: 创伤应激反应, 钙代谢, 喉返神经损伤 , 超声刀, 甲状腺切除术

Abstract:

 Objective To investigate the effect of harmonic scalpel in open small incision thy-roidectomy, and observe the postoperative stress reactions, serum calcium level and recurrent laryngeal nerve injury（RLNI）. Methods Eighty cases of patients undergoing thyroidectomy in our hospital were enrolled in the study. According to different surgical Methods, the patients were divided into the observation group and the control group. The control group（n=40）were treated by conventional thyroidectomy, while the observation group（n=40）were treated through a small incision for thyroidectomy and harmonic scalpel was used during the operation in observation group. The operation time, intraoperative blood loss and postoperative drainage volume were compared between the two groups. The levels of white blood cell count（WBC）, C reactive protein（CRP）, procalcition（PCT）were detected before operation and 3 days after operation. The degree of RLNI and changes of blood calcium were monitored. Results The operation time, intraoperative blood loss and postoperative drainage volume in the observation group were significantly less than those in the control group （all P values <0.05）. WBC, CRP, PCT levels were increased significantly in two groups, and the increase was more significant in the control group than in the observation group （all P values <0.05）. The incidence rates of hypocalcemia and transient RLNI were significantly higher in the control group than the observation group （42.5% and 20.0% vs 17.5% and 5.0%）（all P values <0.05）. Conclusion There is an obvious superiority of harmonic scalpel in open small?incision thyroidectomy than conventional thyroidectomy，such as shorter operation time，less blood loss, lower traumatic reactions after operation, and less serum calcium disorder and RLNI.

Key words: harmonic scalpel, traumatic stress reactions, recurrent laryngeal nerve injury, calcium metabolism, thyroidectomy