目的 探讨超声刀在开放性小切口甲状腺手术中的应用效果。方法 总结我科于2004年4月至2007年12月期间对89例甲状腺良性疾病患者开展的开放性小切口(3～4 cm)甲状腺切除术，手术中采用超声刀代替传统的结扎和缝扎方法对甲状腺血管和腺体进行处理。结果 手术平均时间70(40～135) min，术中平均出血量15(5～20) ml，术后24 h平均切口引流量25(10～50) ml。无出血、神经、甲状旁腺损伤及其他并发症。切口Ⅰ类/甲级愈合，术后平均住院时间5(3～6) d。结论 超声刀应用于开放性小切口甲状腺切除，可以方便手术操作，提高手术效率，止血效果可靠，有特有的实用价值。
Objective To investigate the effect and surgical skill of ultracision harmonic scalpel in curative gastrectomy for patients with gastric carcinoma. Methods From January 2007 to May 2008, the data of 152 patients who were treated by curative gastrectomy with ultracision harmonic scalpel were analyzed retrospectively. Results The mean operative time was (189.5±24.2) min. Compared with the conventional operation, the number of harvested lymph nodes (mean: 30.4±11.6) in patients treated with ultracision harmonic scalpel was increased. The application of ultracision harmonic scalpel could shorten the operation time, decrease the intraoperative blood loss and make the operation field clear. There were no postoperative complications, such as anastomotic leakage, lymphatic leakage and massive hemorrhage. And there was no death in this series. Conclusion The usage of ultracision harmonic scalpel which could improve the curative degree of lymphadenectomy is safe in curative gastrectomy for patients with gastric carcinoma.
ObjectiveTo observe the therapeutic efficacy of ultrasonic scalpel flap-retentiong surgery combined with automatic hemorrhoid ligation for the treatment of four degree mixed hemorrhoids. MethodsThe patients with four degree mixed hemorrhoids admitted to the Third Affiliated Hospital of Henan University of Traditional Chinese Medicine from January 2023 to June 2023 were included as the study subjects, then were randomly averagely divided into an observation group (underwent ultrasonic scalpel flap-retentiong surgery combined with automatic hemorrhoid ligation) and a control group (underwent Milligan-Morgan hemorrhoidectomy) by a random number table method. The therapeutic efficacy, total hospitalization time, operation time, intraoperative blood loss, wound healing time, hospitalization costs, postoperative pain score, bleeding score, wound edema score, postoperative complications (anal stenosis, urinary retention, anal incontinence), and recurrence were compared between the two groups. ResultsA total of 100 patients with four degree mixed hemorrhoids treated in this hospital were included, with 50 patients in each group. There were no statistically significant differences in the general information such as the gender, age, disease course, body mass index, hematochezia, and tumor prolapse between the two groups (P>0.05). ① The overall therapeutic efficacy both the observation group and the control group was well (100% versus 96.0%, Fisher exact test, P=0.495). ② The observation group had less total hospitalization time, operation time, intraoperative blood loss, hospitalization costs, and wound healing time as compared with the control group (P<0.05). ③ The differences in the interaction effects of the time-group for the points of postoperative pain, bleeding, and wound edema were not statistically significant (χ2=6.668, P=0.083; χ2=5.500, P=0.139; χ2=6.204, P=0.102). However, the main effects of group (χ2=5.073, P=0.024; χ2=7.107, P=0.008; χ2=8.857, P=0.003) and time (χ2=188.526, P<0.001; χ2=212.472, P<0.001; χ2=185.110, P<0.001) showed statistically significant differences. The points of postoperative pain, bleeding, and wound edema in the observation group were statistically lower than thoes in the control group (χ2=9.323, P=0.002; χ2=18.133, P<0.001; χ2=6.232, P=0.013). ④ The incidences of postoperative urinary retention and anal stenosis in the observation group were lower than those in the control group (P=0.046 and 0.031, respectively), there were no statistically significant differences in the incidences of incontinence and postoperative recurrence between the two groups (P>0.05). ConclusionFrom the preliminary research results of this study, ultrasonic scalpel flap-retentiong surgery in combination with automatic hemorrhoid ligation has a better efficacy in treating four degree mixed hemorrhoids, with a smaller wound, faster healing, higher safety, and fewer complications.
Objective To assess the feasibility and adequacy of Harmonic Scalpel in a totally laparoscopic total mesorectal excision (TME) and low,ultralow,colo-anal anastomoses for rectal cancer. Methods Excision of the mesorectum and low，ultralow site anastomoses were performed laparoscopically on 30 patients with low rectal cancer based on the concept of TME. Results All 30 TME were successfully completed by laparoscopic approach, and no one was converted to open procedures. A cholecystectomy and/or an ovariotomy were meanwhile performed laparoscopically for 3 patients with rectal cancer,and 1 patient with chronic cholesyctitis, gallstone,ovarian cyst and torsion of the ovary. The operation time was 155 min (115-320 min). Operative blood loss was 20 ml (5-80 ml).The time of bowel function returned and the time to resume postoperative diet was 1-2 days after the operation. Fourteen patients had postoperative analgesic requirement. Average hospital stay was 8 days (5-14 days) and there were no intraoperative and postoperative complications in all 30 patients.Conclusion Laparoscopic excision of the mesorectum and low,ultralow,coloanal anastomoses with Harmonic Scalpel for low rectal cancer is a perspective minimally invasive technique, which is feasible, safe, effective and has dramatic high rates of sphincter preservation with decreased postoperative pain, rapid recovery.
ObjectiveTo summarize the use of harmonic scalpel to harvest bilateral internal mammary artery in coronary artery bypass grafting (CABG). MethodsThe clinical data of 54 patients of bilateral skeletonized internal mammary artery harvesting for CABG in our hospital from January 2016 to May 2020 were analyzed retrospectively. There were 51 males and 3 females with a mean age of 62.37±9.56 years. ResultsAll patients went through the procedure unevently and discharged from hospital. The number of grafts was 4.07±0.85 per patient, the operation time was 267.21±47.00 min, mechanical ventilation time was 342.43±132.17 min and hospital stay was 12.21±4.43 d. ConclusionIt is safe and effective to use harmonic scalpel to harvest skeletonized bilateral internal mammary artery in CABG.
目的 探讨超声刀在肝包虫全囊切除术中的应用。方法 回顾性分析11例接受超声刀肝包虫手术患者的治疗及效果。结果 9例患者行全囊切除，其中1例因包虫与胆管相通，在进行全囊切除后，缝扎胆管，同时行T管引流； 1例因包虫与膈肌粘连无法分离，给予外囊大部切除术； 1例因包虫与膈肌粘连无法分离，给予外囊大部切除术； 1例10岁患者为肝顶部包虫，手术行内囊切除及外囊大部切除后，出现残腔感染，经穿刺引流后，证实为漏胆，经引流后痊愈出院。9例全囊切除患者术中均未输血，术后未出现并发症。结论 在肝包虫全囊切除术中应用超声刀是安全、有效的。
【Abstract】ObjectiveTo study the application of ultrasonically activated scalpel in laparoscopic intestinal adhesion release.MethodsIntestinal adhesion release with ultrasonically activated scalpel under laparoscope was performed in 29 patients suffered from intestinal adhesive obstruction after gynecological operation. ResultsAll operations were successfully performed, and none of them converted into open surgery. Intestinal disruption occurred durring operation in 2 patients with extensive intestinal denseadhesion which were mended successfully under laparoscope. The operative duration was 30-150 min (mean 45 min). Postoperative complications such as bowel leakage, bleeding, abdominal infection were not experienced. Postoperative hospital stay was 3-7 days (mean 4 days). No case had relapse symptom such as abdominal distention or pain after 1-24 months of followup. ConclusionCompared with electric scalpel, ultrasonically activated scalpel can improve the operative safety, lessen tissue damage, shorten operative time, and reduce the chance of relapse in laparoscopic operation in gynecology.
Objective To compare the efficacy and complication between harmonic scalpel and traditional electric knife in open thyroidectomy. Methods A total of 160 thyroid disease patients who underwent open thyroidectomy in The Fifth Affiliated Hospital of Southern Medical University from February 2016 to January 2017, were collected and divided into harmonic scalpel group and traditional electric knife group randomly, each group enrolled 80 patients. The efficacy of thyroidectomy, postoperative pain, and complication between the 2 groups were compared and analyzed. Results Compared with the traditional electric knife group, the operation time, intraoperative blood loss, postoperative drainage volume, postoperative drainage time, length of incision, and hospital stay were all significantly lower in the harmonic scalpel group (P<0.05). The incidences hoarseness, wound bleeding, hypoparathyroidism, and total complication in the harmonic scalpel group were all lower than those of the traditional electric knife group (P<0.05). The pain scores after operation in the harmonic scalpel group were significant lower than corresponding pain scores of the traditional electric knife group (P<0.05). Conclusion The harmonic scalpel could effectively improve the efficacy of open thyroidectomy, reduce the pain degree and the incidence of complication in thyroid disease patients.
Objective To study the application of ultracision harmonic scalpel in laparoscopic radical gastrectomy. Methods Ten patients with gastric cancer were given laparoscopic-assisted radical gastrectomy by using ultracision harmonic scalpel. Results All operations were successfully performed with ultracision harmonic scalpel, and none of which converted into open surgery. The operation time was 300-492 min, mean (385±64) min. The blood loss was 100-500 ml, mean (401±70) ml. The number of harvested lymph nodes was 21-43, mean 31±6. The time for gastrointestinal function recovery was 3-6 d, mean (4.2±1.0) d. The time of patients’ taking out-of-bed activity was 3-７ d, mean (4.5±1.3) d. The time of taking liquid food was 4-６ d, mean (5.0±0.9) d. No case had relapse or metastasis after 4-20 months (mean 12.6 months) of follow-up. Conclusions Laparoscopic radical gastrectomy by using ultracision harmonic scalpel is safe and feasible. Ultracision harmonic scalpel has the advantage of minimal invasion, less bleeding and shorter operation time, which is a very important equipment and useful for laparoscopic gastrointestinal surgery.