皮下不同分离面积对胸乳径路内镜甲状腺手术影响的前瞻性随机对照研究  

Influence of Different Subcutaneous Dissection Area on the Outcomes of Breast Approach Endoscopic Thyroidectomy:a Prospective Randomized Study

作　　者：吴庆华[1] 张伟[1] 单成祥[1] 刘晟[1] 郑向民[1] 江道振[1] 仇明[1] 

机构地区：[1]第二军医大学附属长征医院普外三科,上海200003

出　　处：《中国微创外科杂志》2014年第3期196-200,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨不同的皮下分离面积对胸乳径路内镜甲状腺手术效果的影响。方法按纳入、排除及剔除标准将我科2011年9月～2012年3月连续65例胸乳径路内镜甲状腺手术按随机数字表随机分为2组：标准分离组（n=32）和有限分离组（n=33）。标准分离组皮下分离方式和范围按传统胸乳径路内镜甲状腺手术操作；有限分离组前胸壁皮下分离采用改良技术，从中央切口建立3条皮下狭长隧道，使分离范同限于乳腺上部胸壁。比较2组术中、术后情况。结果标准分离组皮下分离面积显著大于有限分离组[（136．6±23．1）cm2 vs．（93．9±14．8）cm2 ，t=8．525，P=0．000]。2组切口长度[（26．4±0．9）mmVS．（26．6±0．8）mm，t=-0．910，P=0．345]，手术时间[（110．7±23．9）minVS．（117．2±25．1）min，t=-1．027，P=0．309]，术中出血量[（8．0±3．4）mlVS．（8．4±5．1）ml，t=-0．356，P=0．723]，术后48h血清c反应蛋白增量[2．2（-1．8～7．3）mg／LVS．1．2（-2．6～8．6）mg／L，Z=-0．658，P=0．516]、IL-6增量[0．6（-1．9～4．8）Pg／ml vs．1．1（-1．3～5．3）pg／ml，Z=-0．030，P=0．980]，术后12、24、48hVAS评分均无统计学差异（P〉0．05）。2组术后0～12h和12～24h恶心呕吐发生率无统计学差异[23．3％（7／30）VS．36．7％（8／30），x2=0．089，P=0．766；10．0％（3／30）VS．10．0％（3／30），x2=0．000，P=1．000]；2组术后短暂性低钙血症发生率无统计学差异[3．3％（1／30）VS．6．7％（2／30），x2=0．000，P=1．000]；2组术后胸壁感觉异常及麻木感发生率无统计学差异[36．7％（11／30）vs．20．o％（6／30），x2=2．052，P=0．152]。2组术后24h引流量和48h总引流量无统计学差异[（74．3±23．8）ml VS．（64．2±24．4）ml，t=1．623，P=0．110；（121．7±37．1）ml VS．（106．8±40．5）ml，t=1．486，P=0．143]。结论皮下分离面积Objective To investigate the influence of subcutaneous dissection area on surgical outcomes of breast approach endoscopic tbyroidectomy. Methods The study prospectively enrolled 65 consecutive patients according to the selection and exclusion criterion from September 2011 to March 2012 in Shanghai Changzheng Hospital. The patients were randomized into standard dissection group （n = 32） and limited dissection group （ n = 33 ）. Subcutaneous separation in the standard dissection group followed traditional breast approach endoscopic thyroidectomy, while separation in the anterior chest wall in the limited dissection group adopted a modified technique which established three subcutaneous narrow tunnels from the central incision, limiting the separation scope to the upper chest wall above the breasts. The intra- and post-operative records of the two groups were compared. Results Subcutaneous dissection area in the standard dissection group was significantly larger than that in the limited dissection group [ （136.6 ± 23.1 ） cm2 vs. （93.9±14.8） cm2, t=8.525, P=0.000]; the length of incisions [（26.4±0.9） mm vs. （26.6±0.8） mm, t= -0.910, P=0.345], operative time [（110.7 ±23.9） min vs. （117.2±25.1） min, t = -1.027, P =0.309], intraoperative blood loss [（8.0±3.4） ml vs. （8.4 ±5. 1） ml, t = -0.356, P=0.723], postoperative increments of serum concentration of C-reactive protein （ P = 0. 516） and IL-6 （ P = 0. 980） , postoperative drainage volume （ P 〉 0. 05 ）, and postoperative VAS scores （ P 〉 0.05 ） were not significantly different between the two groups. There were no statistical differences in the incidence rate of postoperative nausea and vomiting, transient hypocalcemia, and chest wall paresthesia and numbness between the two groups （ P 〉 0. 05 ）.Conclusions Subcutaneous dissection area should not be regarded as a main influential factor for postoperative outcomes in breast approach endoscopic thyroidectomy such as postoperative pain, vomiting, dra

关 键 词：内镜 甲状腺切除术 皮下分离 

分 类 号：R653[医药卫生—外科学]