改良内镜下甲状腺手术疗效分析  

Clinical application of modified endoscopic thyroidectomy

作　　者：郑炳行[1] 师天雄[1] 邓建伟[1] 

机构地区：[1]广东省中山市人民医院普外二科,528403

出　　处：《中华耳鼻咽喉头颈外科杂志》2013年第10期818-822,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的 比较改良的经胸壁乳晕入路内镜下甲状腺手术与传统经胸壁部分乳晕入路甲状腺手术患者的临床疗效.方法 回顾性分析2002年9月至2012年9月内镜下行甲状腺手术患者480例病历资料,其中2009年9月1日以后,共190例采用改良的经胸壁乳晕入路的内镜下甲状腺手术（改良组）,2009年9月1日以前290例行传统的经胸壁部分乳晕入路的内镜下甲状腺手术（传统组）.比较两种术式的手术时间、穿刺孔的部位及大小、术中失血量、术后住院时间,并采用视觉模拟评估（visual analog scores,VAS）法对术后疼痛进行评估,术后随访时比较两组并发症发生情况,并进行瘢痕主观美观满意度调查.采用x2检验、t检验和单因素方差对数据进行分析.结果 两组患者术后随访12个月,改良手术组患者穿刺孔为（15.5 ±4.9）mm、对照组为（20.6±7.6）mm（t =2.42,P =0.046）；改良组术中失血量为（16.2±4.5）ml,对照组为（30.5±11.4）ml（t =2.53,P=0.032）；术后第1天疼痛评分改良组和对照组分别为（1.5±0.4）分和（1.0±0.2）分（t=4.68,P=0.020）；术后3个月时随访瘢痕美观满意度（x2=6.20,P＜0.05）；术后胸壁麻木感改良组和对照组分别为0和72.4％（x2=380,P=0.0002）;术后出血发生率改良组和对照组分别为0和1.7％ （x2=3.92,P＜0.05）；两组患者在手术时间、术后住院时间、肿瘤复发率差异无统计学意义（P值均＞ 0.05）.结论 改良的经胸壁乳晕入路内镜下甲状腺手术是一种安全有效的美容手术.Objective To compare clinical outcomes of endoscopic thyroidectomy via mammary areola approach and conventional via chest wall and breasts approach.Methods A total of 480 cases undergoing endoscopic thyroidectomy for thyroid nodules between September 2002 and September 2012 were reviewed,including 280 cases via the chest wall and breasts approach between September 2002 and August 2009 and 190 cases via mammary areola approach between September 2002 and September 2012.The mean operation time,the location and diameter of the puncture pore,intraoperative bleeding volume,the mean hospital stay after surgery,postoperative pain score scaled by visual analog scores （VAS） were compared between groups.After 3-month follow-up,long term post-surgical complications,the recurrence rates of nodules and scar cosmetic satisfaction evaluation were also compared.Statistical methods including x2 test,Students＇ test and ANOVA analysis were applied.Results Two groups were followed for 12 months.The differences between groups were statistically obvious in variables of diameters of the puncture pore （15.5 mm ± 4.9 mm vs.20.6 mm ± 7.6 mm,t =2.42,P =0.046）,intraoperative bleeding volume （16.2ml ±4.5 ml vs.30.5 ml ± 11.4 ml,t =2.53,P =0.032）,pain score on the first day after operation（1.5 ±0.4） and （1.0 ± 0.2）,（t =4.68,P =0.020）,scar cosmetic satisfaction evaluation 3 months after operation （x2 =6.20,P 〈 0.05）,chest wall numbness （0 vs.72.4%,x2 =380,P =0.000）.But there were no significant differences in the mean operation time,the mean hospital stay after surgery,and the recurrence rates of nodules between two groups.Conclusion Minimally invasive endoscopic thyroidectomy via mammary areola approach is a safe and effective method for the surgery of thyroid nodules with good aesthetic outcome.

关 键 词：甲状腺切除术 内窥镜检查 手术后并发症 

分 类 号：R653[医药卫生—外科学]