开放性锁骨上入路甲状腺肿瘤切除术美观度的应用探讨  

Evaluation of the Aesthetic Effect of Open Supraclavicular Thyroidectomy

作　　者：邓洁 晋舒 马霖杰 蒋明芳 王少新 Deng Jie;Jin Shu;Ma Linjie;Jiang Mingfang;Wang Shaoxin(Department of Otolaryngology-Head and Neck Surgery,the First People’s Hospital of Ziyang,Ziyang 641300,Sichuan,China;Department of Head and Neck Surgery,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,School of Medicine,University of Electronic Science and Technology of China,Chengdu 610041,Sichuany China)

机构地区：[1]四川省资阳市第一人民医院耳鼻喉头颈外科,四川资阳641300 [2]四川省肿瘤医院·研究所四川省癌症防治中心电子科技大学医学院头颈肿瘤外科,成都610041

出　　处：《肿瘤预防与治疗》2022年第3期273-279,共7页Journal of Cancer Control And Treatment

摘　　要：目的:研究开放性锁骨上入路甲状腺肿瘤切除术切口美观满意度,探索开放性锁骨上入路甲状腺肿瘤切除术疗效及临床应用价值。方法:纳入四川省肿瘤医院头颈外科二病区B治疗组于2018年1月至2018年11月间行单侧甲状腺肿瘤切除术患者,分为行开放性锁骨上入路甲状腺肿瘤切除术组(A组)与传统经颈前切口入路甲状腺肿瘤切除术组(B组),术后随访1年,纳入美观满意度量表,比较两组手术疗效与术后切口美观满意度情况。结果:纳入研究病例51例,其中A组22例,B组29例,两组手术失血量、手术时间、术后促甲状腺激素、甲状旁腺激素、血钙、白细胞值、住院时间、病检淋巴结转移率差异无统计学意义。随访1年后切口美观满意度量表评价结果提示:切口≤5 cm A组18例(81.82%),B组12例(41.38%),差异有统计学意义(P=0.004);无切口积液A组17例(77.27%),B组14例(48.27%),差异有统计学意义(P=0.036);“V”型领衣物能遮住切口A组20例(90.91%),B组2例(6.90%),差异有统计学意义(P<0.001);无颈部活动障碍A组19例(86.36%),B组16例(55.17%),差异有统计学意义(P=0.017)。两组术后切口裂开、切口流脓、切口红肿、瘢痕增生发生率差异无统计学意义。整体切口满意度>5分A组20例(90.91%),B组11例(37.93%),差异有统计学意义(P<0.001)。结论:开放性锁骨上入路甲状腺肿瘤切除术相比传统经颈前切口入路甲状腺肿瘤切除术,在保证手术效果的同时,具有更好的美观度,值得临床上运用推广。Objective:To study the aesthetic effect of the incision after open supraclavicular thyroidectomy,and explore the efficacy and clinical value of open supraclavicular thyroidectomy.Methods:This randomized controlled trial included patients undergoing unilateral thyroidectomy via open supraclavicular approach(group A)and via traditional anterior cervical approach(group B)in section 2 of the department of head and neck surgery in Sichuan Cancer Hospital from January 2018 to November 2018.Both groups were followed up for 1 year with an aesthetic effect scale.The two groups were compared in surgical efficacy and feedback on the aesthetic effect of the surgery.Results:51 cases were included in the study,including 22 cases in group A and 29 cases in group B.There were no significant differences between the two groups in intraoperative blood loss,operation time,length of stay,lymph node metastasis and postoperative thyroid stimulating hormone,parathyroid hormone,blood calcium,and leukocyte value.A follow-up with an aesthetic effect scale 1 year after surgery showed that differences between group A and group B in‘incision≤5 cm’[18 cases(81.82%)vs 12 cases(41.38%),P=0.004],‘no wound fluid’[17 cases(77.27%)vs 14 cases(48.27%),P=0.036],‘surgical incision can be hidden under V-necks’[20 cases(90.91%)vs 2 cases(6.90%),P<0.001]and‘no neck mobility impairments’[19 cases(86.36%)vs 16 cases(55.17%),P=0.017]were statistically significant;and there were no significant differences between the two groups in incidences of postoperative scar hyperplasia,incision dehiscence,pus,redness and swelling.Generally,20 cases(90.91%)in group A and 11 cases in group B(37.93%)were satisfied with the aesthetic effect of the surgery(P<0.001).Conclusion:Compared with thyroidectomy via traditional anterior cervical approach,thyroidectomy via open supraclavicular approach ensures both surgical and aesthetic effects,which is worthy of clinical promotion.

关 键 词：开放性锁骨上入路 传统经颈前切口入路 美观度 

分 类 号：R736.1[医药卫生—肿瘤] R730.56[医药卫生—临床医学]