经胸骨切迹入路与经胸骨上窝入路腔镜辅助甲状腺手术的比较

Comparison between Suprasternal Notch and Suprasternal Fossa Approaches for Video-assisted Thyroidectomy

目的探讨经胸骨切迹入路腔镜辅助甲状腺手术的安全性和可行性。方法 2009年1月~2010年9月,51例单侧甲状腺病变分别采用2种入路行腔镜辅助甲状腺手术,其中胸骨切迹入路27例,经胸骨上窝入路24例,分别记录其切口长度、手术时间、出血量和手术相关不良事件等。结果 51例均顺利完成手术,无中转开放手术。胸骨切迹组手术时间、探查甲状腺时间分别为（13.9±6.0）min、5 min（2.0~20.0 min）明显长于胸骨上窝组（11.0±2.4）min（t=2.136,P=0.035）、2.5 min（2.0~5.0 min）（Z=3.490,P=0.000）。胸骨切迹组术中出血量和切口长度分别为（22.0±11.8）g和2 cm（2.0~2.5cm）,与胸骨上窝组（17.4±10.3）g（t=1.474,P=0.147）和2 cm（1.7~2.8 cm）（Z=0.284,P=0.777）比较无统计学意义。2组均无手术并发症发生。结论经胸骨切迹入路与胸骨上窝入路腔镜辅助甲状腺手术有相似的安全性和可行性。

Objective To evaluate the safety and feasibility of minimally invasive video-assisted thyroidectomy（MIVAT） through suprasternal notch approach（SNA）. Methods From January 2009 to September 2010,51 patients with unilateral thyroid lesion underwent MIVAT in our hospital through either SNA（27 cases） or suprasternal fossa approach（SFA,24 patients）.The operation time,length of the incision,intraoperative blood loss,and surgical complications were recorded and compared between the two groups. Results All the operations were successfully completed without conversion to open surgery.In SNA group,the mean operation time and thyroid exploration time were（13.9±6.0） minutes and 5 minutes（2.0-20.0 minutes） respectively,which were significantly longer than those in the SFA group [（11.0±2.4） minutes（t=2.136,P=0.035） and 2.5 minutes（2.0-5.0 minutes,Z=3.490,P=0.000）].No significant difference was found in the intraoperative blood loss and incisional length between the two groups [（22.0±11.8） g vs.（17.4±10.3） g,t=1.474,P=0.147;2 cm（2.0-2.5 cm） vs.2 cm（1.7-2.8 cm）,Z=0.284,P=0.777].No surgical complications occurred in either of the groups. Conclusion SNA is as safe and feasible as SFA for MIVAT.