甲状腺双侧腺叶病变单侧胸前入路内镜手术与传统手术对比研究  

Comparison of endoscopic monolateral anterior chest approach and conventional approach on thyroid bilateral gland lobe disease

作　　者：蔡谦[1] 黄晓明[1] 孙伟[1] 郑亿庆[1] 卢星[1] 郭明明[1] 陈斌[1] 梁发雅[1] 韩萍[1] 

机构地区：[1]中山大学附属第二医院耳鼻咽喉头颈外科,广州510120

出　　处：《中华耳鼻咽喉头颈外科杂志》2009年第11期926-929,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的比较单侧胸前入路内镜手术与传统术式在处理甲状腺双侧腺叶病变方面的优缺点。方法将2006年6月-2008年3月在中山大学附属第二医院耳鼻咽喉头颈外科进行无注气内镜单侧胸前入路甲状腺双侧腺叶手术的患者20例设为内镜组，同期传统手术病例24例作为传统手术组。内镜组病例入选标准：既往无甲状腺等颈部疾病手术病史，无放疗史；结合术前CT和甲状腺功能检查选择考虑为良性肿块性病变。两侧瘤体直径均小于4cm，其中有一侧的瘤体直径要小于2cm，位于腺叶的中下部，并且靠近腺体表面。两组比较指标为术式、并发症、手术时间、住院时间、切口美容效果、切口疼痛情况。结果内镜组和传统手术组病例的年龄和性别相匹配，在住院天数、术后引流量、术后疼痛评分方面差异无统计学意义（P值均〉0．05），内镜组术中出血量少于传统组、美观性好，但手术时间较长、住院费用较高。随访6个月至2年，两组均无永久性声带麻痹和低钙血症出现，无复发病例。内镜组有1例发生术后皮下血肿；1例发生暂时性声带麻痹，1个月后恢复。两组并发症发生率差异无统计学意义（x^2=2．514，P=0．201）。结论无注气内镜单侧胸前入路可以很好地对经选择的甲状腺双侧腺叶的病变进行处理，和传统手术比较，美观效果显著。Objective To study on thyroid bilateral gland lobe disease with endoscopic monolateral anterior chest approach. Methods Twenty patients experienced thyroid bilateral gland lobe surgery with endoscopic monolateral anterior chest approach; 24 experienced conventional surgery simultaneously and were enrolled in control group. Two groups were compared at surgical style, complications, surgical time, length of stay in hospital, incision cosmetic result and incision pain etc. Criteria of patients selected for thyroid bilateral gland lobe surgery with endoscopic monolateralanterior chest approach： with no surgical history of thyroid or other neck-related diseases and no chemotherapy ; diagnosed with benign tumor according to presurgery CT result and thyroid functional examination. Diameter of tumor on both sides should be smaller than 4 cm, one side smaller than 2 cm, located at lower middle part of gland lobe and near to gland surface. Results Patients in both groups matched in age and sex; scorings on surgical style, hospital stay, postoperative drainage, and postoperative pair/were not significantly distinctive. Endoscopic group had less bleeding volumn than conventional group during surgery, better cosmetic results, but longer surgical duration and higher cost of hospitalization. Both groups occurred no permanent glottic paralysis and hypocalcemia, no recurrence. Endoscopic group had one case eechymoma; one case temporary glottic paralysis; both recovered in one month. Complication incidence in both groups was not significantly distinctive （X^2 = 2. 514, P = 0. 201 ）. Conclusions Gasless endoscopic monolateral anterior chest approach can well treat selected thyroid bilateral gland lobe disease and with a better cosmetic result than conventional surgery.

关 键 词：内窥镜检查 甲状腺切除术 对比研究 临床分析 

分 类 号：R686[医药卫生—骨科学]