局部麻醉下腔镜辅助小切口甲状腺手术的可行性探讨

Feasibility of Local Anesthesia for Minimally Invasive Video-assisted Thyroidectomy

目的对比研究局部麻醉和全身麻醉条件下完成腔镜辅助小切口甲状腺手术(MIVAT)的效果,探讨局麻条件下完成手术的安全性。方法 2008年1月～2009年10月对110例行MIVAT,其中局麻下手术90例(局麻组),全麻下手术20例(全麻组),记录手术时间、术中出血量、医疗费用和手术并发症。结果 110例均顺利完成手术,无中转开放手术。局麻组手术时间、术中出血量和手术相关费用的中位数分别为60.0min(35～120min)、14.8g(4.2～56.1g)和2868.0元(1537～3469元),全麻组分别为60.0min(35～100min)、10.8g(4.3～52.4g)和2938.0元(2286～3601元),差异无显著性(P>0.05)。局麻组和全麻组麻醉相关费用的中位数分别为379.5元(185～2227元)和2098.0元(577～3051元),全麻组费用明显高于局麻组(Z=6.567,P=0.000)。暂时性声音嘶哑局麻组3例,全麻组1例,2组差异无显著性(P>0.05)。术后1～3d痊愈出院。结论局部麻醉下MIVAT是可行的,在保障安全的前提下,大幅度降低医疗费用。

Objective To compare the safety and feasibility of local and general anesthesia in minimally invasive video-assisted thyroidectomy （MIVAT）. Methods From January 2008 to October 2009,totally 110 patients underwent MIVAT in our hospital. Among them,local anesthesia was carried out in 90 cases,while general anesthesia was employed in 20 cases. The operation time,intraoperative blood loss,hospital cost,and surgical complications were recorded during the surgery,and compared between the two groups. Results The operation was completed in all of the patients without converting to open surgery. No significant difference was detected in the medium operation time,intraoperative blood loss,and surgery-related cost between the two groups [local anesthesia group：60.0 min （35-120 min）,14.8 g （4.2-56.1 g）,and 2868.0 RMB （1537-3469 RMB） vs. general anesthesia group：60.0 min （35-100 min）,10.8 g （4.3-52.4 g）,and 2938.0 RMB （2286-3601 RMB）,P0.05]. Whereas,the anesthesia-related cost in the local anesthesia group was significantly lower than that in the general anesthesia group [medium cost：379.5 RMB （185-2227 RMB） vs. 2098.0 RMB （577-3051 RMB）,Z=6.567,P=0.000]. After the operation,three patients in the local anesthesia group and one patient in the general anesthesia group showed transient hoarseness （P0.05）. All of the patients were discharged from hospital in one to three days after the operation. Conclusions MIVAT under local anesthesia is safe and feasible,while generates lower cost than general anesthesia.