3种甲状腺手术方式的比较

A comparison of three different approaches of thyroid surgery

目的比较3种甲状腺手术的优缺点。方法该院2003年3月～2008年10月,统计306例3种甲状腺手术的资料,其中乳晕入路内镜下甲状腺手术116例(完全内镜组),颈前小切口内镜辅助甲状腺手术90例(内镜辅助组),传统开放手术100例(传统组),比较3组的手术时间、术中出血量、住院时间、住院费用、术后并发症、术后疼痛、术后不适及美容效果。结果306例均成功完成手术。完全内镜组和内镜辅助组的手术时间较传统组明显延长(F=32.458,P=0.000),住院费用增加(F=26.401,P=0.000),术中出血量明显减少(F=56.802,P=0.000),术后出现颈前感觉异常减退、吞咽不适明显减少,但完全内镜组术后可出现胸前紧张感。内镜辅助组的住院时间较完全内镜组和传统组缩短(F=36.068,P=0.000),术后24h疼痛较其他两组明显减轻(χ2=17.453,P=0.001)。3组并发症发生率无统计学差异。完全内镜组术后美容效果最佳,内镜辅助组次之,传统组最差(χ2=38.260,P=0.000)。结论完全内镜甲状腺手术美容效果最佳,创伤较大,比较适合年轻女性或有特殊职业需求的患者。内镜辅助甲状腺手术适应面更广,创伤最小,灵活易学,更容易推广。

[Objective] To compare the advantages and shortcomings of three different routes of thyroid surgery. [Methods] A total of 306 patients with thyroid diseases from March 2003 to October 2008 in this hospital were divided into three groups： 116 patients via areola papillaris approach （the total endoscopic group）, 90 patients via the cervical single small incision approach（the video-assisted endoscopic group）, 100 patients via conventional open approach （the open group）. The operating time,blood loss,hospital stay, hospital cost, complications after operation, postoperative pain assessment, sensory discomfort after operation, and cosmetic outcomes among the three groups were compared. [Results] Operations were successfully performed in 306 cases. In the total or video-assisted endoscopic group, the operating time was significantly longer （F=32.458, P =0.000）, the intraoperative blood loss was less （F=56.802, P=0.000） and the hospital cost was more （F=26.401, P=0.000） than that in the open group, jugular hypesthesia and discomfort at swallowing after operation occurred infrequently, but in total endoscopic group chest tension after operation sometimes occurred. The hospital stay in the video-assisted endoscopic group was significantly shorter than that in the total endoscopic group and the open group （F=36.068, P =0.000）, pain 24 hours after operation was slighter （ 2=17.453, P=0.001）. There was no significant difference in postoperative complications of the three groups. The cosmetic outcome was the best in the total endoscopic group, better in the video-assisted endoscopic group, the worst in the open group （ 2=38.260, P=0.000）. [Conclusions] The total endoscopic approach has the best cosmetic outcomes, much operation-related trauma, is adapted for young women or special professional patients; the video-assisted endoscopic approach has wider adaptive range with advantages of less trauma, flexibility and easy learning, wider acceptance and easy generalization.