机器人手术与传统开放手术治疗甲状腺良性结节的临床疗效及创伤应激反应对比分析  

Comparative analysis on clinical efficacy and traumatic stress of benign thyroid nodules with robotic surgery and traditional open surgery

作　　者：张安 陈为凯 黄小段 汪文杰 李坤[2] 曹廷宝[2] 阎龙 李乐[2] 王文安 王婧 余稳稳[2,4] 郭长安 周海存[2,4] 彭军瑞 于建平[2] 陶瑞雨 魏登文[2] 李洪涛 许淑梅 王新平 刘宏斌 ZHANG An;CHEN Weikai;HUANG Xiaoduan;WANG Wenjie;LI Kun;CAO Tingbao;YAN Long;LI Le;WANG Wenan;WANG Jing;YU Wenwen;GUO Changan;ZHOU Haicun;PENG Junrui;YU Jianping;Tao Ruiyu;WEI Dengwen;LI Hongtao;XU Shumei;WANG Xinping;LIU Hongbin(Clinical Medical College,Gansu University of Chinese Medicine,Lanzhou 730000,China;Department of General Surgery,the 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army,Lanzhou 730050,China;Department of Otorhinolaryngology Head and Neck Surgery,the 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army,Lanzhou 730050,China;Second Clinical Medical College,Lanzhou University,Lanzhou 730000,China)

机构地区：[1]甘肃中医药大学临床医学院,甘肃兰州730000 [2]中国人民解放军联勤保障部队第940医院普通外科,甘肃兰州730050 [3]中国人民解放军联勤保障部队第940医院耳鼻喉头颈外科,甘肃兰州730050 [4]兰州大学第二临床医学院,甘肃兰州730000

出　　处：《机器人外科学杂志（中英文）》2020年第3期186-194,共9页Chinese Journal of Robotic Surgery

基　　金：甘肃省自然科学基金(1606RJZA177)。

摘　　要：目的:探讨达芬奇机器人手术系统采用单侧腋窝双侧乳晕术式治疗良性甲状腺结节的临床疗效、创伤应激反应及远期疗效。方法:采用前瞻性非随机化队列研究的方法,招募2017年12月~2019年6月就诊于中国人民解放军联勤保障部队第940医院普通外科行手术治疗的良性甲状腺结节患者共102例。其中53例患者行达芬奇机器人甲状腺切除手术,设为机器人组。49例患者行传统开放甲状腺切除手术,设为开放组。收集患者基本信息及围手术期相关临床指标进行比较,术后采用门诊或电话的形式重点对出现吞咽功能、美容效果、胸部感觉异常、永久性喉返神经损伤、声带损伤等并发症的患者进行随访。在术后第1个月、3个月、6个月个月进行喉镜检查声带,超过6个月的喉返神经损伤定义为永久性喉返神经损伤。结果:机器人组手术时间长于开放组,手术费用高于开放组,术中出血量少于开放组。两组患者在年龄、性别、BMI、结节直径、术后住院时间、总引流量、术后并发症、术后24h和48h疼痛评分方面比较,均无明显差异。机器人组术后24h IL-6、CRP明显低于开放组,机器人组术后48h CRP明显低于开放组。随访结果显示,达芬奇机器人甲状腺切除术在术后12h疼痛评分、术后美容评分及吞咽功能优于传统开放甲状腺切除术,颈部损伤方面则劣于传统开放甲状腺切除术,两组患者间语音障碍评分比较,差异无统计学意义。结论:达芬奇机器人手术系统治疗良性甲状腺结节安全可行,具有侵入性低、吞咽功能及美容效果好等优势。Objective:To study the clinical effect,traumatic stress response and long-term effect of benign thyroid nodules treated by unilateral axillary bilateral areola with Da Vinci robotic surgery system.Methods:Prospective nonrandomized cohort study was taken and 102 patients who had been treated for benign thyroid nodules during Dec.2017 and Jul.2019 at the 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army were selected.53 patients were treated with Da Vinci robotic thyroidectomy as the robotic group,others were performed traditional open thyroidectomy as the open group.Basic information and related clinical indicators in perioperation of the selected 102 patients were collected for comparing.Information on swallowing function,cosmetic results,chest paresthesia,permanent recurrent laryngeal nerve injury and vocal cord injury were mainly collected by following-up in clinic or telephone after operation.Furthermore,the patients’vocal cords were respectively examined with laryngoscope at the first,third and sixth months after the surgeries,and recurrent laryngeal nerve injury which last more than six months can be defined as permanent injury.Results:No case in robotic group converted to open group during the study.The robotic group has a longer operation time than the open group,and operation cost of robotic group is also higher than the open group.However,the intraoperative blood loss of the former is less than the latter.There were no significant differences between the two groups in terms of ages,gender,BMI,nodule diameter,postoperative hospitalization time,total drainage,postoperative complications,and the pain scores after 24 and 48 hours operation respectively.After 24 hours of the operation,the interleukin-6(IL-6)and C-reactive protein(CRP)in the robot group were significantly lower than those in the open group.Besides,after 48 hours of the operation,the CRP in the robot group was significantly lower than that in the open group.Follow-up results showed that the robotic group’

关 键 词：甲状腺切除术 良性甲状腺结节 机器人手术系统 应激反应 美容评分 

分 类 号：R653[医药卫生—外科学]