完全乳晕入路腔镜甲状腺切除手术的学习曲线

Learning curve of endoscopic thyroidectomy by complete areola approach

目的:探讨具有一定腔镜甲状腺手术经验的医生,完全乳晕入路腔镜甲状腺切除术的学习曲线。方法:回顾分析开展这项技术后的最初80例因甲状腺良性疾病行完全乳晕入路腔镜甲状腺切除术的临床效果。按手术日期将80例分为4组(A、B、C、D),每组20例,比较各组的手术时间、术中出血量、术后低钙血症、喉返神经损伤、伤口引流管量、术后止痛药使用及术后住院时间差异。结果:4组病例在年龄、性别和手术方式等方面差异无统计学意义(P>0.05),A组手术时间分别为(94.9±9.8)min,长于B组(87.5±9.9)min、C组(87.6±7.4)min和D组(87.1±6.8)min,(P<0.05);A组的术中出血量为(16.5±10.9)mL,多于B组(10.3±3.3)mL、C组(10.5±4.3)mL和D组(10.1±2.1)mL(P<0.01);术后低钙血症、喉返神经损伤、伤口引流管量、术后止痛药使用、术后住院时间等临床指标差异无统计学意义。结论:具有一定腔镜甲状腺手术经验的医生,经过约20例完全乳晕入路腔镜甲状腺切除术后,可以安全度过这一手术的学习曲线。

Aim：To analyze the learning curve for an experienced endoscopy surgeon in performing endoscopic thyroidectomy by complete areola approach. Methods： The first 80 admitted patients with both side nodular goiter or hyperthyroidism underwent endoscopic thyroidectomy by complete areola approach were devided into four groups（n=20） based on the surgery date.The clinical data was retrospectively evaluated including the mean operating time,the mean blood loss,the injury of the recurrent laryngeal nerve or parathyroid,the wound drainage,the postoperative consumption of analgesics,the length of postoperative hospital stay were compared. Results： No statistical differences were found among the groups in age,gender,ratio of kind of surgery（P〈0.05）.The mean operating time in group A（94.9±9.8 min） was longer than the other groups（P〉0.05;B：87.5±9.9 min,C：87.6±7.4 min,D：87.1±6.8 min）.The intraoperative mean blood loss in group A（16.5±10.9 mL） was more than the other groups（P0.01;B： 10.3±3.3 mL,C： 10.5±4.3 mL,D：10.1±2.1 mL）.The wound drainage,the postoperative consumption of analgesics,the length of postoperative hospital stay were equivalent in all groups.There were no intraoperative or postoperative large hemorrhage,no injury to the recurrent laryngeal nerve or any other serious postoperative complications in each group. Conclusion：For a well-trained endoscopy surgeon,the learning curve of endoscopic thyroidectomy by completely areola approach is about 20 cases.