无充气经锁骨下入路完全腔镜双侧甲状腺腺叶手术的效果初探  

Preliminary study on the effect of complete endoscopic bilateral thyroidectomy using the sub-clavian approach

作　　者：黄建康[1] 陈春春[1] 甄卫东 王苏杭 彭德峰[1] 马小开[1] 李玉龙[1] 钱军[1] HUANG Jian-kang;CHEN Chun-chun;ZHEN Wei-dong;WANG Su-hang;PENG De-feng;MA Xiao-kai;LI Yu-long;QIAN Jun(Department of Oncology,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233000,China)

机构地区：[1]蚌埠医学院第一附属医院肿瘤外科,233000

出　　处：《天津医药》2020年第11期1101-1105,共5页Tianjin Medical Journal

基　　金：安徽省高校青年教师科研研究项目(2006JQ1182);蚌埠医学院科技发展基金重点项目(Bykf12A06);蚌埠市科技计划项目(20120318)。

摘　　要：目的探讨无充气经锁骨下入路完全腔镜双侧甲状腺腺叶切除术的可行性及安全性。方法回顾性分析43例双侧甲状腺全切术患者的临床资料。其中13例行无充气经锁骨下入路完全腔镜双侧甲状腺腺叶切除手术(腔镜组),30例行传统开放手术(开放组)。记录2组手术时间、术中出血量、术后引流量、术后第1天甲状旁腺素(PTH)、术后住院时间、手术并发症及美容满意度等。结果腔镜组患者年龄(46.2±10.1)岁小于开放组(57.4±7.9)岁(P<0.05);而2组间性别比例、肿块直径、肿瘤性质差异无统计学意义(P>0.05)。腔镜组手术时间[(124.2±15.8)min vs.(92.9±9.7)min]及术后引流量[(147.1±42.9)mL vs.(103.7±16.5)mL]均较开放组增多(P<0.01);但术中出血量[(26.1±8.5)mL vs.(37.0±10.9)mL]较开放组减少。2组患者术后第1天PTH、住院时间比较差异无统计学意义(P>0.05);腔镜组术后美容满意度高于开放组(P<0.05)。结论无充气经锁骨下入路完全腔镜双侧甲状腺腺叶切除手术安全、可行,美容效果较佳,值得推广。Objective To explore the feasibility and safety of complete laparoscopy bilateral thyroid lobectomy through subclavian approach without inflation.Methods The clinical data of 43 patients with bilateral total thyroidectomy in the first ward of the First Affiliated Hospital of Bengbu Medical College from December 2019 to April 2020 were retrospectively analyzed.Among them,13 cases underwent complete laparoscopy bilateral thyroid lobectomy(laparoscopy group)without gas-filled subclavian approach,and 30 cases underwent traditional open surgery(open group).The operation time,intraoperative blood loss,postoperative drainage volume,parathormone(PTH)on the first postoperative day,postoperative hospital stay,surgical complications and cosmetic satisfaction were recorded in the two groups.Results The age of the laparoscopy group(46.2±10.1)was less than that of the open group(57.4±7.9,P<0.05).There were no significant differences in gender ratio,tumor diameter and tumor nature between two groups(P>0.05).The operation time[(124.2±15.8)min vs.(92.9±9.7)min]and the amount of drainage fluid[(147.1±42.9)mL vs.(103.7±16.5)mL]were higher in the laparoscopy group than those in the open group(P<0.05).The intraoperative blood loss[(26.1±8.5)mL vs.(37.0±10.9)mL]was less in the laparoscopy group than that of the open group.There were no significant differences in hospitalization time and postoperative PTH at first day of operation between the two groups(P>0.05).The postoperative cosmetic satisfaction was higher in the endoscopic group than that of the open group(P<0.05).Conclusion The complete laparoscopy bilateral thyroid lobectomy without air-filled subclavian approach is safe,feasible and has a better cosmetic effect,which is worthy of promotion.

关 键 词：甲状腺切除术 内窥镜 无充气 锁骨下入路 

分 类 号：R653.2[医药卫生—外科学]