经胸前壁入路内镜甲状腺手术与传统甲状腺手术的临床效果比较  

Breast approach endoscopic thyroidectomy and conventional thyroidectomy:a comparison of clinical benefits

作　　者：姜治国[1] 单成祥[1] 郑向民[1] 江道振[1] 张伟[1] 刘晟[1] 仇明[1] 

机构地区：[1]第二军医大学附属长征医院微创外科中心,上海200003

出　　处：《上海医学》2010年第3期220-222,共3页Shanghai Medical Journal

摘　　要：目的通过临床前瞻性非随机对照研究,比较经胸前壁入路内镜甲状腺手术和传统甲状腺手术后患者疼痛、功能恢复和美观满意度的情况,探讨经胸前壁入路内镜甲状腺手术的临床效果。方法收集24例行经胸前壁入路内镜甲状腺手术的患者为内镜组,19例行传统甲状腺手术的患者为开放组。采用疼痛视觉模拟评分(VAS评分)比较两组在术后2、12、24和48h的疼痛情况;观察术后开始自行下床、洗漱和进食的时间,以比较两组患者的康复情况;应用numerical score system(NSS)评分系统比较两组患者在术后1、3个月时对切口瘢痕的美观满意度。结果内镜组在术后2、12和24h的疼痛VAS评分分别为(2.92±0.50)、(2.93±0.81)和(1.15±0.44)分,均显著低于开放组的(3.78±0.69)、(5.42±0.85)(2.03±0.61)分(P值分别<0.05、0.01)。内镜组自行下床、洗漱的时间分别为术后(18.2±4.5)、(26.4±7.6)h,均显著早于开放组的(23.2±3.9)、(37.1±6.9)h(P值均<0.05)。两组间自行进食时间的差异无统计学意义(P>0.05)。术后1和3个月,内镜组的NSS评分分别为(7.88±1.11)、(6.58±0.93)分,均显著高于开放组的(3.84±1.50)、(2.79±1.23)分(P值均<0.01)。结论相对于传统甲状腺手术,经胸前壁入路内镜甲状腺手术具有术后疼痛轻、功能恢复快和美观满意度高等优点。Objective To evaluate the clinical benefits of breast approach endoscopic thyroidectomy by comparing the postoperative pain, postoperative functional recovery and cosmetic satisfaction with those of conventional thyroidectomy in a prospective nonrandomized study. Methods Twenty-four patients who were to undergo breast approach endoscopic thyroidectomy were enrolled in the endoscopic group and nineteen patients who were to undergo conventional thyroidectomy were enrolled in the conventional group. Visual analog scale （VAS） scores of postoperative pain were obtained for patients in the two groups 2, 12, 24, and 48 h after surgery. The time span of recovery to normal activity, including independently walking, washing and eating, was recorded. The postoperative cosmetic satisfaction was evaluated at 1 month and 3 months after surgery by using numerical score system （NSS）. Results The VAS scores in the endoscopic group were significantly lower than those in the conventional group at 2, 12 and 24 h after surgery （2.92±0.50 vs. 3.78±0.69, P0.05;2.93±0.81 vs. 5.42±0.85, P 0.01;1.15±0.44 vs. 2.03±0.61, P 0.01, respectively）. The time spans of recovery to independently walking and washing in the endoscopic group were significantly shorter than that in conventional group （[18.2±4.5] h vs. [23.2±3.9] h, P0.05; [26.4±7.6] h vs. [37.1±6.9] h, P0.05, respectively）. The time spans of recovery to independently eating in two group were not significantly different （[21.2±3.9] h vs. [25.3±7.1] h, P0.05）. The NSS score of postoperative cosmetic satisfaction was significantly higher in endoscopic group than in conventional group at 1 month and 3 months after surgery （7.88±1.11 vs. 3.84±1.50, P0.01; 6.58±0.93 vs. 2.79±1.23, P0.01, respectively）. Conclusion Compared with the conventional thyroidectomy, breast approach endoscopic thyroidectomy offers quicker postoperative functional recovery and higher cosmetic satisfaction with less postoperative pain.

关 键 词：经胸前壁入路内镜甲状腺手术 传统甲状腺手术 疼痛 功能恢复 美观满意度 

分 类 号：R653[医药卫生—外科学]