经腋乳和经胸乳两种途径的腔镜甲状腺手术比较

Endoscopic thyroidectomy:a comparison of the trans-axilloareolar approach and the trans- thoracoareolar approach

目的探讨经腋乳途径和经胸乳途径的腔镜甲状腺手术的方法并比较其优缺点。方法对2003年12月至2006年1月术前诊断为良性甲状腺疾病的238例患者采用腔镜进行手术。将其随机分为经腋乳途径组123例,经胸乳途径组115例。结果两组手术均获成功。经腋乳途径组与经胸乳途径组手术时间为(69±29)min 与(70±25)min(P>0.05),术中出血量为(38±11)ml与(40±13)ml(P>0.05),术后住院天数为(4±1.3)d 与(4.5±1.2)d(P>0.05),对手术后美容效果的满意度为97.5%(120/123)与85.2%(98/115)(P<0.05)。238例患者均无手术并发症,无一例中转开放手术。颈部引流管术后24～36h 拔除。结论两种手术方式均具有较好的美容效果,但经腋乳途径美容效果比经胸乳途径更佳。术式需根据患者的要求及手术者的技术条件来选择。

Objective To evaluate the advantages and shortcomings of endoscopic thyroid surgery by trans-axilloareolar approach and trans-thoracoareolar approach. Methods Endoscopic thyroidectomy was performed in 238 cases from December 2003 to January 2006. The patients were randomly divided into two groups. One hundred and twenty-three patients received the trans-axilloareolar approach and 115 patients randomly received the trans-thoracoareolar approach procedure. Results All the operations were successed. The operating duration of trans-axiiloareolar approach group and trans-thoracoareolar approach group were （69±29） minand （70±25） min （P〉0.05）, the blood lost were （38±ll）mland （40±13） ml （P〉 0,05）, the average hospitalized days were （4 ± 1.3） d and （4.5 ± 1.2） d （P〉0.05）, the rate of satisfaction with the cosmetic effects of the procedures were 97.5% and 85.2% （ P 〈0. 05 ）. There were no conversions to open surgery or any complications. The drainage was removed at 24 h to 36 h after the operation. Conclusions Endoscopic thyroideetomy through trans-axilloareolar approach and trans- thoraeoareolar approach is feasible, safe and cosmetic. The cosmetic effects of the trans-axilloareolar approach is better than the trans-thoraeoareolar approach. The procedure selection depends on both the patient request and the technology of the surgeons.