胸乳径路腔镜甲状腺手术中改进胸壁分离方法的临床研究

The clinical research of improving the chest separation methods in endoscopic thyroidectomy via thoracic and mammary approach

目的对比腔镜甲状腺手术中改进胸壁分离方法与传统方法的临床效果。方法将70例行经胸乳径路腔镜甲状腺手术患者分为改进组(35例)与传统组(35例),改进组采用充分利用Trocar长度,经各切口建立隧道会师于胸壁上部空间的方法,传统组采用扇形分离至胸壁上部空间的方法,比较两组临床治疗效果。结果改进组与传统组相比,胸壁皮下剥离面积缩小了31.37%,改进组中72 h内引流量、胸前皮瓣区皮肤淤斑发生率、术后疼痛等指标优于传统组,差异有统计学意义(P<0.05);手术时间、术中出血量、一过性声嘶、低钙性抽搐等指标在两组间差异无统计学意义(P>0.05)。结论经胸乳径路行腔镜甲状腺手术时,采用改进胸壁分离方法可提高临床效果。

Objective To compare the clinical efficacy of improving the chest separation methods and original methods in endoscopic thyroidectomy via thoracic and mammary approach. Methods 70 patients with thyroid diseases were divided into two groups. The improvement group with 35 patients took full advantage of the length of Trocar when separating the skin of chest to create tunnels via each incision to meet at the upper chest space. The control group with 35 patients used the original fan-shaped separation methods to meet at the upper chest space. Then statistical methods were used to estimate the clinical effects of the two groups. Results As compared with the original group, the separated areas of subcutaneous of chest were decreased 31.37% in the improvement group. And the volume of postoperative drainage within 72 hours, the incidence rate of skin ecchymosis as well as postoperative pain of the improvement group were superior to the control group, the difference was significant（P〈0.05）. However, the operative time, peri-operative bleeding, transient hoarseness and low calcium seizures between the two groups were no significant difference（P〉0.05）. Conclusion Adopting this improved methods in endoscopic thyroidectomy via thoracic and mammary approach which could enhance clinical effect.