目的 比较使用腔镜剪刀+超声刀与单纯超声刀进行皮瓣游离在腔镜甲状腺手术中的疗效及安全性差异。方法 将128例患者随机分为两组,其中腔镜剪刀+超声刀60例、单纯超声刀68例。记录两组在分离皮瓣的耗时、气体用量、出血量、术后48 h皮下引流量,术后随访1个月,记录患者局部皮肤感觉异常情况。结果 所有患者均无须中转。两组在出血量、48 h皮下引流量、1个月后局部皮瓣感觉异常差异无统计学意义（P>0.05）。但在分离皮瓣耗时、气体用量方面存在差异（P<0.05）。结论 腔镜剪刀+超声刀的合理使用可快速扩大腔镜甲状腺操作空间,特别是在游离胸前区皮瓣时。同时能减少气体用量,缩短游离皮瓣时间,并不增加术中出血量、术后48 h皮下引流量。此法安全有效,值得推广。

Objective To compare the efficacy and safety of endoscopic scissors plus ultrasonic scalpel and ultrasonic scalpel only to free flap during endoscopic thyroidectomy. Methods A total of 128 patients were randomly divided into two groups, including 60 cases using endoscopic scissors plus ultrasonic scalpel and 68 cases using ultrasonic scalpel only. The free flap time, gas consumption, blood loss, and subcutaneous drainage 48 h after surgery were recorded for both groups. Postoperative follow-up was conducted 1 month after the surgery to record patients' local skin paresthesia. Results All surgeries were performed well. No significant differences were found between the two groups in the amount of blood loss, subcutaneous drainage at 48 h, and local flap paresthesia after 1 month (P> 0.05). However, the free flap time and gas consumption were significantly different (P<0.05). Conclusion The reasonable application of endoscopic scissors plus ultrasonic scalpe can expand the operating space for endoscopic thyroidectomy rapidly, especially for the free flap of thoracic region. Meanwhile, it can reduce the amount of gas consumption and shorten the time of free flap, without increasing the amount of intraoperative blood loss and subcutaneous drainage 48 h after surgery. This method is safe and effective, thus it is worth popularizing.