胸前壁乳晕入路内镜甲状腺手术的回顾性分析

A retrospective study on endoscopic thyroidectomy via the breast wall approach

目的:总结取胸前壁乳晕入路作内镜甲状腺手术治疗的经验,并以此指导临床适应证的选择。方法:回顾性分析单一术者,连续400例采取胸前壁乳晕入路施行内镜甲状腺手术的临床资料。取前200例按时间顺序平均分为10组,每组20例。统计包括病人一般情况、手术方式、手术难度分组、手术时间、并发症等数据。用统计学方法分析各组甲状腺手术难度分组构成比及手术时间等差别。结果:平均手术时间为104.55min;各组病人的一般资料、术后并发症等无明显差别;各组手术难度分组有统计学差异(P<0.05);各组手术时间均数有显著统计学差异(P<0.01),相邻组间第3组与第4组有统计学差异(P<0.05)。结论:胸前壁乳晕入路内镜甲状腺手术是治疗甲状腺肿瘤的一个安全、有效的手术方式。经过60例内镜甲状腺手术学习曲线早期阶段后,可将手术适应证适当放宽。

Objective To summarize the experience of endoscopic thyroidectomy via the breast wall approach and to redjust its indications. Methods A retrospective study on 400 patients undergoing endoscopic thyroidectomy via the breast wall approach by a single surgeon. The clinical data included demographic parameters, procedure style, operating time and complications. The first 200 cases were collected and divided into 10 consecutive groups, each comprising 20 cases. The difficuhy level and the duration of operative procedure of the groups were analyzed by aid of Pearson＇s chisquare test and one-way analysis of variance. Results The mean duration of operation was 104.55 min. No difference was noted among the groups in the term of demographic data and complications, while there were significant differences in difficulty level （P〈0.05） and duration of operation （P〈0,01）. Comparing the duration of operation between consecutive groups, there was difference between groups 3 and 4 （P〈0.05）. Conclusions The endoscopic tbyroideetomy via the breast wall approach is a safe and effective procedure for treating thyroid tumor. After the 60-case early stage of the learning curve, the indications of the procedure could be widened.