Analysis of the clinical effect of small incision in the thyroid surgery uni- lateral by sternocleidomastoid inside edge

目的 探讨单侧经胸锁乳突肌内侧缘小切口入路甲状腺手术的临床效果。方法 选择2013年1月～2016年1月厦门大学医院收治入院的行甲状腺手术患者100例作为研究对象,按随机数字表法分为观察组和对照组,每组50例。观察组采用单侧经胸锁乳突肌内侧缘小切口入路的手术方式,对照组采用颈白线正中入路的手术方式。观察两组患者手术总时间、显露甲状腺时间、术中出血量、住院时间、切口长度,记录两组患者术后并发症,并进行统计学分析。结果 观察组患者手术总时间、显露甲状腺时间、术中出血量、住院时间、切口长度等指标均明显优于对照组,差异均有统计学意义（P〈0.05）;观察组患者术后出现并发症3例,发生率为6.0%,对照组患者术后出现并发症18例,发生率为36.0%,观察组患者并发症发生率明显低于对照组,差异均有统计学意义（P〈0.05）。结论在甲状腺患者行手术时采用单侧经胸锁乳突肌内侧缘小切口入路可以获得更为清晰的解剖层次,有利于减少手术损伤,对提高患者的治疗效果具有重要的意义。Objective To study the unilateral by sternocleidomastoid inside edge the clinical effect of small incision in the thyroid surgery.Methods 100 patients with thyroid surgery from January 2013 to January 2016 in Xiamen Univer- sity Hospital were selected as the research object,according to random number table method they were divided into ob- servation group and control group,50 cases in each group.Patients of the observation group were given the unilateral sternocleidomastoid inside edge small incision in the way of operation,and the control group was given the operation with the center of the white line into the neck surgery way.The total time,expose thyroid time,intraoperative blood loss, hospitalization time,incision length of patients in two groups were observed,postoperative complications of patients in the two groups were recorded and statistical analyzed.Results The total time of operation,time of revealing thyroid,intra- operative blood loss,hospital stay,incision length of the observation group were significantly better than the control group,the differences were statistically significant （P〈0.05）;3 patients with postoperative complications of the observa- tion group,arid the incidence was 6.0%;while 18 patients with postoperative complications in the control group,and the incidence was 36.0% ,the the incidence of postoperative complications in the observation group was significantly lower than the control group,the difference was statistically significant （P〈0.05）.Conclusion Thyroid surgery with unilateral sternocleidomastoid inside edge small incision approach can get more clear anatomical level,is conducive to reducing surgical injury,has the vital signifi,eance to improve the treatment effect of patients

肛瘘切开术与切除术治疗低位单纯性肛瘘中的价值

目的分析比较肛瘘切开术与切除术治疗低位单纯性肛瘘的价值。方法方便选择2014年7月—2016年7月该院所收治的120例明确诊断为低位单纯性肛瘘患者进行研究。按照随机数字表法分为肛瘘切开组(n=60)和肛瘘切除术组(n=60),两组采用相同的术前准备、麻醉方式和术后管理。对比两组手术操作时间和术中出血量,研究分析两组术后切口愈合时间、切口并发症(疼痛、出血及感染)、复发率、早期排便次数、大便失禁和狭窄并发症发生率。结果肛瘘切开术组手术操作时间为(16.1±2.3)min,肛瘘切除术组手术操作时间为(13.8±3.2)min,两组数据差异有统计学意义(t=4.520 8,P=0.013 1);肛瘘切开术组手术切开愈合时间为(22.5±4.5)d,肛瘘切除术组手术愈合时间为(28.8±4.6)d,两组数据差异有统计学意义(t=8.91,P=0.010 1);肛瘘切开术组早期排便次数为(1.5±0.5)次,肛瘘切除术组早期排便次数为(2.5±1.5)次,两组数据差异有统计学意义(t=3.167,P=0.002)。而两组在术中出血量、术后因切口疼痛导致的镇痛药使用率、切开疼痛评分方面差异无统计学意义(P>0.05)。术后随访1年,肛瘘切开术组患者术后复发率高于肛瘘切除术组,差异有统计学意义(P0.05)。结论肛瘘切除术与切除术在治疗低位单纯性肛瘘方面,操作简单,伤口较小,手术操作时间短、恢复快,但远期复发率高于肛瘘切除术