腔镜下甲状腺手术与传统开放性手术临床疗效对比

Clinical Effect Comparison of Endoscopic Thyroidectomy and Traditional Open Operation

目的:比较腔镜下甲状腺手术与传统开放性甲状腺手术的临床治疗效果。方法:对2009年1月至2013年3月在我院行腔镜下甲状腺手术与传统开放手术治疗的200例患者进行分析比较,其中腔镜甲状腺手术组102例(腔镜组),传统开放手术组98例(传统组),比较两组的手术时间、术中出血量、术后引流量、拔管时间、住院时间、术后3及6个月美容效果评分(numerical score system,NSS)及并发症情况。结果:200例腔镜甲状腺手术成功完成,无中转开放手术;腔镜组平均手术时间、引流总量,拔管时间以及住院时间均明显高于传统组,差异具有统计学意义(P<0.05);术中出血量则明显低于传统组(P<0.05);术后腔镜组声音嘶哑、饮水呛咳及颈部感觉异常等并发症明显低于传统组(P<0.05),而皮下积液和皮下气肿明显高于传统组(P<0.05);腔镜组术后3个月及术后6个月NSS评分均明显高于传统组,差异有统计学意义(P<0.05)。结论:腔镜下甲状腺手术临床疗效较传统开放性手术相比,具有手术出血较少,神经损伤率低以及美容效果优异等优势,但也存在一些并发症,需严格按照其适应证对患者进行选择,尊重患者自主选择权,增进医患和谐。

Objective： To compare the clinical effect of endoscopic thyroidectomy and open operation. Methods： 200 patients who underwent endoscopic thyroidectomy （endoscopic group, n=102） and open operation （traditional group, n=98） in our hospital from January 2009 to March 2013 were selected. The operative time, blood loss, drainage tube drainage amount, time of extubation, hospitalization time, NSS score after 3 and 6 months and complications of the patients were analyzed. Results： 200 cases of endoscopic thyroidectomy were completed successfully without conversions to open operation. The operative time, drainage tube drainage amount, time of extubation and hospitalization in endoscopic group were higher than those in traditional group （P〈0.05）. The blood loss in endoscopic group was less than that in traditional group （P〈0.05）. The complications incidence such as hoarseness, drinking cough and neck sensory abnormalities were less than that in traditional group （P〈0.05）. The complications incidence such as subcutaneous effusion and subcutaneous emphysema were higher than that in traditional group（P〈0.05）. NSS scores after 3 and 6 months were higher than those in traditional group （P〈0.05）. Conclusion： Compared with traditional open operation, clinical effect of endoscopic thyroidectomy have some advantages, such as less blood loss, low rate of nerve injury and fme cosmetic result, but it also has lots of complications. Thus, the endoscopic thyroidectomy should be applied to the patients according to the indication strictly, and the patients＇ autonomy in choosing the method of operation should also be respected, which may enhance the harmony between doctors and patients.