全乳晕径路内镜术式与开放甲状腺手术术后综合征比较的回顾性队列研究  

Post-thyroidectomy syndrome following endoscopic thyroidectomy via areola approach vs open operation:a retrospective cohort study

作　　者：俞黎[1] 胡原[2] 包皙婷[1] 刘鑫[1] 施毅卿[1] 蒋奕玫[1] 项明[1] 吴庆华[1] Yu Li;Hu Yuan;Bao Xiting;Liu Xin;Shi Yiqing;Jiang Yimei;Xiang Ming;Wu Qinghua(Department of General Surgery,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 201801,China;Department of Otorhinolaryngology,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院普外科,201801 [2]上海交通大学医学院附属瑞金医院耳鼻咽喉科,200025

出　　处：《中华内分泌外科杂志》2021年第4期382-386,共5页Chinese Journal of Endocrine Surgery

基　　金：上海市嘉定区科委课题(JDKW-2016-W01)。

摘　　要：目的评估和分析甲状腺切除术后综合征在内镜术式与开放手术术后的发生情况。方法回顾性分析上海交通大学医学院附属瑞金医院普外科2016年1月至2017年12月收治的903例患者,包括良性结节性甲状腺肿和分化型甲状腺癌病例。年龄范围为20~66岁,男231例,女672例。按术式的不同分为全乳晕径路内镜甲状腺手术组(162例)及开放甲状腺手术组(741例)。术中采取统一的手术操作原则,术后单日引流量少于20 ml则拔管出院。使用独立样本t检验及重复测量方差分析方法,比较2组在术后1、3、6个月及1年在5项甲状腺切除术后综合征相关指标及术后1年36条目简明健康量表评分情况。结果2组随访期均在1年以上,删失43例,删失率4.8%。剔除43例后2组人口统计学数据比较差异无统计学意义(P>0.05)。甲状腺切除术后综合征5项指标各阶段评分中位数为0~1,各指标评分随时间因素呈逐步降低表现(P=0.000)。在手术部位异样感及颈部活动不适感方面比较,术后1及3个月2组间比较差异有统计学意义(P=0.000),即术后1及3个月内镜手术组手术部位异样感发生[54例(38.8%)及8例(5.8%)]高于开放手术组[153例(21.2%)及20例(2.8%)];而术后颈部活动不适感内镜手术组[14例(10.1%)及0例]低于开放组[(194例(26.9%)及53例(7.4%)]。在全身乏力、吞咽哽噎及发音感觉障碍比较各阶段差异无统计学意义(P>0.05)。术后1年36条目简明健康量表评分2组间比较差异也无统计学意义(P=0.458)。结论甲状腺切除术后综合征在开放甲状腺手术及全乳晕径路内镜甲状腺手术后均为较常见的症状。其在甲状腺术后早期尤为明显,至术后6个月显著降低。在手术部位异样感方面,术后早期开放术优于全乳晕径路内镜术,在颈部活动不适感方面则相反。Objective To estimate and analyze the occurrence of post-thyroidectomy syndrome(PTS)following endoscopic thyroidectomy via areola approach(ETAA)vs open thyroidectomy(OT).Methods Data of 903 consecutive cases,aged from 20 to 66 with 231 males and 672 females,in Department of General Surgery,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,from Jan.2016 to Dec.2017 were analyzed retrospectively.They were enrolled according to the same criteria.Based on different procedures,the cases were divided into ETAA group(n=162)and OT group(n=741).Intraoperative procedure was according to unified principle.Drainage tube was removed if 24-hour drainage volume was less than 20 ml.Following-up was implemented by telephone or outpatient clinic.Data of 2 groups of 5 PTS items during 1 m,3 m,6 m and 1 y postoperatively and the scores of the medical outcomes study short form 36-item health survey(SF-36)V2 were analyzed by independent sample t test and repeated measures analysis of variance.Results The patients of 2 groups were all followed up for more than 1 y with 43 cases censored(4.8%).Demographic data of the rest of 2 groups were not different statistically(P>0.05).Median of every phase scores of the 5 items of PTS were 0 to 1.Scores of the 5 items were decreased gradually in accordance with time factor(P=0.000).The scores of peculiar feeling at the surgical site and discomfort in neck were different statistically during 1 m and 3 m postoperatively(P=0.000).Incidence of peculiar feeling at the surgical site in 1 m and 3 m postoperatively in ETAA group(54,38.8%and 8,5.8%)was higher than that in OT group(153,21.2%and 20,2.8%).However,incidence of discomfort in neck in ETAA group(14,10.1%and 0)was lower than in OT group(194,26.9%and 53,7.4%).The other 3 items at all phases were not different statistically(P>0.05).The SF-36 V2 scores at 1 y postoperatively of 2 groups were not different statistically(P=0.458).Conclusions PTS is a common symptom after OT or ETAA.It is frequent within early phase after thyroidectomy and

关 键 词：甲状腺切除术 内镜手术 全乳晕径路 甲状腺切除术后综合征 健康相关生存质量 

分 类 号：R653[医药卫生—外科学] R736.1[医药卫生—临床医学]