胸乳入路腔镜与开放手术治疗甲状腺良性肿瘤的对比研究

A Comparative Study of Endoscopic Thyroidectomy via Breast Approach with Conventional Open Thyroidectomy for Benign Thyroid Tumor

目的 对比腔镜手术和开放甲状腺手术治疗甲状腺良性疾病的临床效果.方法 回顾性分析2008年1月～2010年6月54例腔镜和60例开放甲状腺切除术的临床资料.比较2组的手术时间、出血量、术后恢复活动时间、术后并发症和住院费用;采用疼痛视觉模拟评分（VAS评分）比较术后4、12、24和48小时疼痛情况;应用数字评分系统（numericalscore system,NSS）比较2组术后3和6个月对切口瘢痕的满意度.结果 2组手术时间差异无显著性[腔镜组（124.7±35.3） min,开放组（117.9±39.2）min,t＝0.979,P=0.330].腔镜组出血量少[（23.5±11.3）ml vs.（101.0±46.8） ml,t=-12.423,P=0.000],术后恢复活动时间短[（3.1±0.8）d vs.（5.7±1.5）d,t=-3.511,P=0.037];但住院费用高[（10 726.3±413.5）元vs.（7241.2±587.4）元,t=-2.327,P=0.045].腔镜组出现2例声音嘶哑、l例皮下瘀斑,开放组出现1例声音嘶哑、1例甲状腺功能减退,2组并发症发生率差异无显著性（Х^2=0.015,P=0.904）.腔镜组术后4、12、24小时VAS评分分别为（2.16±0.61）、（2.97±0.78）和（1.39±0.43）分,均显著低于开放组的（3.95±0.62）、（5.74±0.90）、（2.55±0.78）分（t=-9.486、-17.565、-9.994,P均＜0.05）;而2组术后48小时VAS评分差异无显著性.术后3和6个月腔镜组的NSS评分分别为（8.74±1.25）、（3.15±1.41）分,均显著高于开放组的（5.68±1.06）、（1.25±1.36）分（t=4.882,P=0.025;t=3.463,P=0.036）.结论 腔镜甲状腺手术具有切口美观、出血少、术后疼痛轻的优点,在治疗甲状腺良性疾病方面具有良好的发展前景.

Objective To compare the clinical effect of endoscopic thyroidectomy with conventional open thyroidectomy.Methods Fifty-four patients underwent endoscopic thyroidectomy and sixty patients underwent conventional open thyroidectomy from January 2008 to June 2010 in our hospital.The operative time,blood loss,postoperative bedridden time,postoperative complications and total expense were compared.Visual analogue scores （VAS） of postoperative pain 4,12,24 and 48 hours after operation were compared between the two groups.Postoperative cosmetic effect was evaluated at 3 and 6 months after the surgery by using numerical score system （NSS）.Results The average operation time of endoscopic group was （124.7 ± 35.3） min and that of open group was （117.9 ± 39.2） min.No statistical difference was found between the two groups （t =0.979,P =0.330）.Blood loss was significantly less in endoscopic group [（23.5 ±11.3） ml] than that of the open group [（101.0 ±46.8） ml] （t =-12.423,P=0.000）.Bedridden time in endoscopic group [（3.1 ±0.8） d] was shorter than the open group [（5.7±1.5） d] （t=-3.511,P=0.037）.Significant difference was found in hospital expenses between endoscopic group and the open group [（10 726.3 ± 413.5） yuan vs.（7241.2 ± 587.4） yuan,t =-2.327,P =0.045].Two patients had hoarseness and one got subcutaneous ecchymosis after operation in endoscopic group,while one patient had hoarseness and one got hypothyroidism in open group.No significant difference was found between the two groups （Х^2 =0.015,P=0.904）.The VAS scores in the endoscopic group were 2.16 ±0.61,2.97 ±0.78 and 1.39 ± 0.43 at 4,12 and 24 h after surgery,which were significantly lower than those of the open group （3.95 ± 0.62,5.74 ± 0.90 and 2.55 ±0.78） （t =-9.486,-17.565 and-9.994,all P 〈 0.05）.No significant difference was found in the VAS scores at 48 h after surgery between the two groups.Compared with open group,NSS score of postoperative cosmetic effect was significantly higher in endoscopic group than in conventional group at 3 and 6 months after surgery （8.74 ± 1.25 vs.5.68 ± 1.06,t =4.882,P =0.025; 3.15 ± 1.41 vs.1.25 ± 1.36,t =3.463,P =0.036）.Conclusions Compared with open surgery,endoscopic thyroidectomy has excellent cosmetic effect,less blood loss and less pain.Endoscopic thyroidectomy has wide clinical application prospect for the treatment of thyroid benign disease.