内镜下小切口甲状腺手术和传统手术的对照研究

Comparison study between small incision of endoscopic thyroidectomy and conventional thyroidectomy

目的通过临床对照研究,评价分析内镜下小切口甲状腺手术组与传统手术组间手术时间、出血量、美容效果、并发症、费用等有无差异,评估该技术是否有效、可行、安全。方法2004年7月～2005年10月对55例甲状腺肿瘤患者施行内镜下小切口甲状腺手术(内镜组),同时对照分析57例在年龄、性别、术式、麻醉、病情轻重、手术医生水平相配匹的同期住院行传统手术病例(传统组)。结果内镜组和传统组所切除的肿块大小10～40mm,平均分别为24.2和26.0mm,无差异;内镜组手术时间(103.73±26.46)min,传统组手术时间(79.86±27.32)min,P<0.001;美容效果内镜组明显好于传统组;内镜组手术失血量(26.65±23.11)mL,传统组手术失血量(45.18±28.95)mL,P<0.001;费用内镜组高于传统组;当外科医生取得经验和应用先进的超声刀技术后,手术时间和失血量明显减少。结论内镜下甲状腺手术与常规手术相比失血量明显要少,美容效果优,但手术时间长,费用多。认为小切口内镜下甲状腺手术是一种切合实际的、低侵袭的、安全的新手术,具有美容的优点,为手术治疗甲状腺肿物提供了一种选择。

[Objective] To evaluate the efficiency, feasibility and safety of small incision endoscopic thyroidectomy （SIET） compared with conventional thyroidectomy（CT）. [Methods] One hundred and twenty-two patients undergoing surgery owing to a thyroid nodule or goiter were allotted to one of these procedures including SIET and CT in the Second Affiliated Hospital of Sun Yat-sen University from July 2004 to Oct 2005. Exclusion criteria was nodules/goiter greater than 40mm. Operative time, operative blood loss, postoperative cosmetic, and complications were evaluated. [Results] SIET group included 55 patients and the CT 56 patients.The operative time was （103.73± 26.46） rain for SIET and （79.86±27.32） min for CT （P 〈0.001）. The operative blood loss was （26.65±23.11） mL for SIET and （45.18±28.95） mL for CT （P 〈0.001）. Cosmetic results evaluated by inquiry table was in favor of SIET. Cost of SIET was more than CT （P 〈0.01）. When surgeons had more experiences and used the advanced harmonic scalpel, the operative time and blood loss reduced significantly. [Conclusion] SIET has the major advantage in trems of operative blood loss and postoperative cosmetics. CT still offers an advantage in terms of operative time and cost. We conclude that this technique has efficiency, feasibility and safety. It can offer another choice for thyroid patients.