腋窝单孔与双乳晕腋窝径路甲状腺手术的比较

Comparative study of trans-axillary single-port and bilateral breast of ipsilateral axillary approach in endoscopic thyroidectomy

目的对比完全内镜双乳晕同侧腋窝径路和完全经腋窝单孔甲状腺手术的临床效果、可行性、安全性。方法回顾性分析2011年5月-2013年9月在我院经完全内镜双乳晕同侧腋窝径路甲状腺手术（BBIAA）和经腋窝单孔甲状腺手术（TASPET）62例患者的临床资料,每组31例患者,比较两组患者的手术时间、手术分离皮瓣面积、手术出血量,术后第一天引流量、VAS疼痛评分、C-反应蛋白（CRP）,以及术后并发症。结果 62例患者均顺利完成手术,随访2～8个月,无复发。两组术中的出血量、术后第一天的引流量无明显差异。BBIAA组的手术时间明显较TASPET组短（P〈0.05）,术后第一天的VAS评分和CRP明显较TASPET组低（P〈0.05）,手术分离的皮瓣面积明显较TASPET组小（P〈0.05）,术后的并发症明显比TASPET组少（P〈0.05）。结论 TASPET和BBIAA两种手术方法均具有很好的美容效果。但综合考虑,BBIAA手术更简便,同时手术创伤小、术后并发症少及术后疼痛轻,是一种值得推广的内镜甲状腺手术径路。

Objective To compare of the clinical efficiency, feasibility and safety between trans- axillary single-port and bilateral breast of ipsilateral axillary approach in endoscopic thyroidectomy. Methods We conducted a retrospective study of 62 patients who were underwent trans-axillary single-port and bilateral breast of ipsilateral axillary approach in endoscopic thyroidectomy in our hospital from May 2011 to Sep. 2013. Patients were divided into two groups, each group had 31 cases. Operative time, the area of skin flap, the amount of bleeding, the first day of postoperative drainage, postoperative visualanalog score （VAS） pain score, C-reactive protein （CRP） , postoperative complications of two groups were compared. Results All patients were successfully operated, there were no recurrence in 8-month follow-up process. The amount of bleeding and the first day of postoperative drainage between the two groups had not no significant difference. Compared with the group of TASPET, the group of BBIAA＇s operative time were shorter （P 〈 0.05）, postoperative VAS pain score and CRP were lower （ P 〈 0.05 ） , the area of skin flap were smaller （ P 〈 0.05 ） , postoperative complications were fewer （ P 〈 0.05 ）. Conclusion The both of trans- axillary singleport and bilateral breast of ipsilateral axillary approach bad a good cosmetic effect. But the bilateral breast of ipsilateral axillary approach was more easier, had little trauma, had few postoperative complications, had light postoperative pain. And the bilateral breast of ipsilateral axillary approach was a surgical procedure which shoud be promoted.