Discussion on the control of bleeding using membrane dissection technique in modified Miccoli thyroidectomy
改良Miccoli术式甲状腺腺叶切除术中运用膜解剖技术的出血控制探讨

摘要

目的 探讨采用膜解剖技术实施改良Miccoli术式甲状腺腺叶切除术期间给予出血控制后对临床手术产生的影响。方法 本次研究对我院2022年10月～2024年11月时间范围内的120例单侧甲状腺乳头癌患者采用膜解剖技术实施改良Miccoli术式甲状腺腺叶切除术；期间依据脑棉片浸染实验，对术中的出血量给予估算，之后划分为术中出血量≥1.0mL者（40例）以及术中出血量＜1.0mL者（80例）；对于术中出血量≥1.0mL者，依据出血位置发生率，进行非危险区出血（10例）以及危险区出血（30例）的划分；临床对比术后并发症以及手术时间差异。结果 术中出血量＜1.0mL者与术中出血量≥1.0mL者比较，手术时间表现为显著性缩短（P<0.05）；术后暂时性喉返神经损伤发生率表现为显著性降低（P<0.05）；术后生化性甲状旁腺功能减退发生率之间差异不明显（P>0.05）；术中出血量≥1.0mL的非危险区出血患者与危险区出血患者比较，手术时间表现为显著性缩短（P<0.05）；术后暂时性喉返神经损伤发生率表现为显著性降低（P<0.05）；术后生化性甲状旁腺功能减退发生率之间差异不明显（P>0.05）。结论 临床对患者在选择膜解剖技术实施改良Miccoli术式甲状腺腺叶切除术治疗期间，确保患者的术中出血量＜1.0mL，而且防止呈现出危险区出血情况，可以将患者的手术时间显著缩短，对于术后并发症的减少可以发挥显著的促进效果。

Abstract

Objective To investigate the effect of bleeding control during modified Miccoli thyroidectomy using membrane dissection technique on clinical surgery.
Methods In this study, 120 patients with unilateral papillary thyroid carcinoma in our hospital in the time range of October 2022~November 2024 were treated with modified Miccoli thyroid lobectomy by membrane dissection technique. During the period, the intraoperative blood loss was estimated according to the cerebral cotton film immersion experiment, and then it was divided into 40 cases with intraoperative blood loss ≥ 1.0mL and intraoperative blood loss < 1.0mL (80 cases), and for those with intraoperative blood loss ≥ 1.0mL, non-risk area bleeding (10 cases) and risk area bleeding (30 cases) were divided according to the incidence of bleeding location, and the postoperative complications and operation time differences were clinically compared.
Results Compared with those with intraoperative blood loss < 1.0mL and intraoperative blood loss ≥ 1.0mL, the operation time was significantly shortened (P<0.05), the incidence of transient recurrent laryngeal nerve injury was significantly reduced (P<0.05), and there was no significant difference in the incidence of postoperative biochemical hypoparathyroidism (P>0.05). Compared with patients with bleeding in the risk zone with intraoperative blood loss of ≥1.0mL, the operation time was significantly shortened (P<0.05). The incidence of transient recurrent laryngeal nerve injury was significantly reduced (P<0.05), and there was no significant difference in the incidence of biochemical hypoparathyroidism after surgery (P>0.05).
Conclusion  s During the treatment of patients with modified Miccoli lobectomy with membrane dissection technology, the intraoperative blood loss of patients is < 1.0mL and the bleeding in the risk zone is prevented, which can significantly shorten the operation time of patients and reduce postoperative complications.