胸乳入路腔镜单侧甲状腺部分切除术与传统开放手术的比较

Breast approach endoscopic thyroidectomy versus conventional thyroidectomy:A comparison study

目的比较胸乳入路腔镜手术与传统开放手术在单侧甲状腺部分切除的临床效果。方法75例单侧甲状腺良性疾病,分别行胸乳入路腔镜手术(腔镜手术组24例)和开放手术(开放手术组51例),比较2种术式的临床治疗效果。结果腔镜手术组1例因瘤体大(直径6cm,曾行注射治疗导致舌骨下颈前肌群粘连)中转开放手术,其余23例均顺利完成手术。腔镜手术组手术时间(100.4±26.6)min显著长于开放手术组(73.5±14.5)min(t=5.627,P=0.000);腔镜手术组术后引流量(66.7±24.9)ml显著多于开放手术组(13.3±6.4)ml(t=14.403,P=0.000);腔镜手术组术后住院时间(4.3±1.1)d显著长于开放手术组(3.6±0.9)d(t=2.886,P=0.005);腔镜手术组住院费用(11572±1675.1)元显著高于开放手术组(5015.9±1211.0)元(t=19.058,P=0.000)。腔镜手术组对手术美容效果表示满意22例明显高于开放手术组34例(χ2=7.235,P=0.007);腔镜手术组术中出血量(22.5±15.3)ml与开放手术组(18.3±7.5)ml无显著差异(t=1.273,P=0.207);术后镇痛腔镜手术组9例,开放手术组21例,2组无显著差异(χ2=0.028,P=0.867)。2组均无术后大出血、喉返、喉上神经损伤、甲状旁腺损伤等严重并发症。75例术后随访6个月,无局部复发。结论胸乳入路腔镜单侧甲状腺部分切除术与传统开放手术均是安全、有效的手术方法,腔镜手术有更加令人满意的美容效果,但术后恢复较慢,费用较高。

Objective To compare the clinical efficacy between endoscopic thyroidectomy via breast approach and conventional open thyroidectomy in patients with nodular goiter. Methods A series of 75 patients with unilateral nodular goiter was divided into two groups, either receiving endoscopic thyroidectomy through breast approach （Endoscopic Group, 24 cases） or conventional open thyroidectomy （Open Group, 51 cases）. The therapeutic efficacy was compared between the two groups. Results In the Endoscopic Group, the endoscopic operation was successfully performed in 23 cases, whereas a conversion to open surgery was needed in 1 case because of large nodule （6 cm in diameter） and extensive adhesion of infrahyoid muscles （ resulted from a previous injection therapy）. The operating time was significantly longer in the Endoscopic Group （ 100.4 ± 26.6 rain） than in the Open Group （73.5 ± 14.5 min） （t = 5. 627; P = 0. 000）. The postoperative drainage volume in the Endoscopic Group （66.7 ± 24.9 ml） was significantly more than that in the Open Group （13.3 ± 6.4 ml） （t = 14. 403, P = 0. 000）. The postoperative hospital stay was significantly longer in the Endoscopic Group （4.3±1.1 d） than in the Open Group （3.6 ±0.9.d） （t =2.886; P=0.005）. The Endoscopic Group had significant higher hospital costs （11 572 ± 1675.1 yuan） than the Open Group （5015.9 ± 1211.0 yuan） （t = 19. 058; P = 0. 000）. And a satisfactory cosmetic result was achieved in significantly more patients in the Endoscopic Group （22/24 cases） than in the Open Group （34/51 cases） （X^2 = 7. 235; P = 0. 007 ）. There was no significant difference in intraoperative blood loss between the Endoscopic Group （22.5 ± 15.3 ml） and the Open Group （18.3 ±7.5 ml）.（t = 1.273; P =0.207）, and in consumption of analgesics between the Endoscopic Group （9/24 cases） and the Open Group （21/51 cases） （X^2 = 0. 028; P = 0. 867）, respectively. No severe complications were encountered, such as massive hemorrhage, injuries of the recurrent or superior laryngeal nerve, or parathyroid gland injury. During a follow-up for 6 months, none of the patients was found recurrence after surgery. Conclusions Both breast approach endoscopic thyroidectomy and conventional open thyroidectomy are safe and effective. The former gives better cosmetic outcomes but Slower recovery and high hospital costs compared to the latter.