峡部入路与上外侧入路方法在改良Miccoli手术中的临床应用

Clinical application of per-isthmus entrance and upward-lateral entrance for modified Miccoli operation

目的探讨峡部入路方法在改良Miccoli手术中应用的效果。方法选择2013年2月～2014年10月抚顺市中心医院收治的行改良Miccoli手术的56例良性甲状腺疾病患者,将其分为峡部入路组（n=30）与上外侧入路组（n=26）,由同一手术组人员完成手术,比较不同入路方法患者手术时间、手术出血量、术后24 h引流量以及术后住院时间的差异。结果 55例患者成功行改良Miccoli手术,上外侧入路组中1例患者术中出血中转开放手术,1例患者出现暂时性声音嘶哑,其余患者未见声音嘶哑、饮水呛咳、手足抽搐等严重并发症。峡部入路组和上外侧入路组的手术时间、手术出血量及术后24 h引流量比较差异有统计学意义（P〈0.05）,术后住院时间比较差异无统计学意义（P〉0.05）。结论峡部入路方法应用在改良Miccoli手术中可缩短手术时间,减少手术出血量及术后引流量,值得临床推广。

Objective To investigate the effects of the approach by per-isthmus entrance for modified Miccoli operation. Methods Fifty six patients with benign thyroid diseases underwent modified Miccoli operation in Fushun Central Hospital from February 2013 to October 2014 were divided into per-isthmus entrance group（n = 30） and upward-lateral group（n = 26）. The operations were completed by the same group of surgeons. The operation time, blood loss, the volume of drainage during the 24 hours after operation and the time of postoperative stay were compared between the two groups. Results Fifty five patients underwent modified Miccoli operation successfully. One patient in upward-lateral entrance group converted to open surgery for blood loss. One patient in upward-lateral entrance group suffered transient hoarseness. No permanent recurrent laryngeal nerve injury, parathyroid injury or other complications occurred in both groups. The differences of operation time, blood loss and the volume of drainage during the 24 hours after operation between the two groups were statistically significant（P〈 0.05）. The difference of the time of postoperative stay was not statistically significant（P〉 0.05）. Conclusion Approach by per-isthmus entrance for modified Miccoli operation can obviously decrease operation time, blood loss and the volume of drainage, which deserves being applied to clinic.