中国普通外科杂志2025，Vol.34Issue(11)：2326-2334,9.DOI:10.7659/j.issn.1005-6947.250582
腔镜甲状腺手术出血的预防与处理
Prevention and management of bleeding in endoscopic thyroid surgery
摘要
Abstract
Endoscopic thyroidectomy(ET)has rapidly evolved over the past three decades and has become a preferred option for patients with cosmetic concerns.Evidence shows that ET offers safety,efficacy,and oncologic completeness comparable to conventional open surgery;however,its confined operative space imposes higher demands on the surgeon's endoscopic skills,spatial perception,and hemorrhage control techniques.Although the overall incidence of bleeding is similar between ET and open thyroidectomy,achieving hemostasis and restoring visualization during ET are more challenging.Postoperative cervical hematoma,though infrequent,may rapidly lead to airway compromise,requiring prompt recognition and intervention.Systematic prevention and management of hemorrhage is therefore essential for ensuring ET safety.Preoperative optimization-including evaluation of bleeding risks and adjustment of thyroid and coagulation status-is fundamental.Intraoperatively,meticulous dissection,judicious use of energy devices,and careful protection of the superior and inferior thyroid vessels as well as microvasculature around the recurrent laryngeal nerve are key.Postoperatively,close monitoring of drainage and cervical contour is required to detect early signs of hematoma formation,enabling timely decompression and re-exploration when needed.Drawing on extensive institutional experience and current literature,this review summarizes the characteristics,risk factors,preventive measures,and management strategies for bleeding in ET.We aim to provide practical and standardized recommendations that enhance surgical safety,reduce severe complications,and support the standardized and high-quality development of endoscopic thyroid surgery.关键词
甲状腺切除术/内窥镜/手术中并发症/出血/止血Key words
Thyroidectomy/Endoscopes/Intraoperative Complications/Hemorrhage/Hemostasis分类
医药卫生引用本文复制引用
马军杰,谢秋萍,徐浩,王平..腔镜甲状腺手术出血的预防与处理[J].中国普通外科杂志,2025,34(11):2326-2334,9.基金项目
浙江省基础公益研究计划基金资助项目(LY24H130001). （LY24H130001）
