乳晕入路腔镜甲状腺切除术与开放手术的临床对比分析

Comparative analysis of areola approach endoscopic thyroidectomy and traditional open thyroidectomy

目的:探讨腔镜技术用于甲状腺手术获得美容效果的临床应用价值及其安全性和可行性。方法:选择2008年1月—2011年08月行甲状腺良性肿物手术的患者80例,其中腔镜甲状腺手术40例(腔镜组),单侧23例,双侧17例;传统开放甲状腺手术40例(开放组),其中单侧22例,双侧18例,2组行单侧大部分切除术或者双侧甲状腺大部分切除术,麻醉方法均采用气管插管全身麻醉。分别比较2种术式单侧和双侧的手术时间、术中失血量、术后住院时间、术后引流量、引流天数、住院费用、术后美容效果、术后并发症。结果:全部病例手术成功,2组均无术后大出血、喉返和喉上神经损伤、甲状旁腺损伤等严重并发症。腔镜组手术时间较长,2组单侧及双侧分别比较差异均无统计学意义(P>0.05);腔镜组术中出血量、住院时间、术后引流量、术后引流时间、术后并发症较开放组少,2组单侧及双侧分别比较差异均有统计学意义(P>0.05)。虽然住院费用腔镜组高于开放组(P<0.05),但腔镜组取得较好美容效果。结论:乳晕入路腔镜甲状腺切除术与开放手术均是安全、有效的手术方法,腔镜手术有更加令人满意的美容效果,有着传统开放甲状腺手术不可比拟的优点,对适应证明确者,应该是值得推崇的手术方式。

Objective： To evaluate the security and feasibility of endoscopic technique used in thyroid surgery. Methods： From January 2008 to August 2011, 80 cases of thyroidectomy were done at our institute. 40 patients underwent endoscopic thyroidectomy （unilateral group 23 cases, bilateral group 17 cases） and 40 patients underwent traditional open thyroidectomy （unilateral group 22 cases, bilateral group 18 cases）. Patients of both groups underwent unilateral or bilateral subtotal thyroidectomy. Anesthesia are general anesthesia with endotracheal intubation.Operative time, in- traoperative blood loss, postoperative hospital stay,postoperative drainage, drainage days, hospital costs,postoperative cosmetic results and postoperative complications were compared between the two procedures. Results： All patients had successful surgery with no postoperative bleeding, throat back, laryngeal nerve damage, parathyroid damage and other serious complications. Laparoscopic operative time was longer, but with no significant difference between unilateral and bilateral group （P〉0.05）. Laparoscopic group had less blood loss, hospital stay, postoperative drainage, postopera- tive drainage time, postoperative complications than the traditional open group, and with significant difference between unilateral and bilateral group（P〈0.05）. Laparescopic surgery group had more hospital cost than the open group（P〈0.05） but achieved better cosmetic results. Conclusion： are- ola approach endoscopic thyroidectomy and open surgery are safe and effective surgical method. La- paroscopic surgery achieved more satisfactory cosmetic results compared with traditional open thy- roidectomy. To clear indications, the laparoscopic operation method is worthy to be recommended.