三维腔镜胸前入路甲状腺癌手术32例临床分析

Three-dimensional total endoscopic thyroidectomy for thyroid carcinoma： a series of 32 cases

目的 总结利用三维腔镜行胸前入路完全腔镜甲状腺癌手术的初步经验.方法 回顾性分析2013年12月至2014年5月32例因单侧甲状腺癌应用三维腔镜系统行单侧甲状腺切除加中央区淋巴结清扫的病例,均为女性患者,平均年龄为（37±10）岁,均经术前B超定位下细针穿刺细胞学检查或术中冰冻切片检查明确为单侧甲状腺乳头状癌.随机抽取同期应用普通腔镜行相同手术的45例女性患者作为对照组进行比较.采用独立样本t检验和x2检验对两组的手术资料进行比较.结果 全组手术获得成功.三维组平均手术时间（91.7±11.4）min,术后平均住院时间（3.2±0.5）d,1例出现术后一过性声音嘶哑,无出血、感染、手足抽搐等并发症.与对照组比较,三维组甲状腺腺叶切除时间明显缩短[（23.2±5.1） min比（28.0±5.0）min,t=4.156,P=0.000],手术总时间[（91.7±11.4） min比（96.1±13.0）min]、空间建立时间[（15.6±2.5）min比（14.6±3.3） min]和中央区淋巴结清扫时间[（25.1±5.4）min比（24.4±6.3）min]无明显优势.结论 三维腔镜技术能够还原手术野立体结构,缩短腺叶切除时间,有利于精细化解剖以及喉返神经、甲状旁腺等重要结构的功能保护.

Objective To summarize the experiences of applying three-dimensional （3D） technique in scarless endoscopic thyroidectomy （SET） via anterior chest approach.Methods Medical records of patients who underwent SET using 3D technique from December 2013 to May 2014 were retrospectively reviewed.A total of 32 patients who had a preoperative ultrasound-guided fine-needle aspiration cytology diagnosis of unilateral papillary thyroid carcinoma and underwent lobectomy associated with central lymph node dissection were included in this study.All patients were female with a mean age of （37 ± 10） years at diagnosis.In addition,45 female patients who underwent traditional endoscopic thyroidectomy at the same period were randomly selected as control.Results All surgical procedures were successfully finished.The mean surgical time in 3D group was （91.7 ± 11.4） minutes,and mean hospitalization time was （3.2 ± 0.5） days.Contemporary hoarseness was observed in one patient,and no bleeding,infection,hypocalcemia and other postsurgical complications were observed.Compared to the traditional endoscopic surgery group,3D group had significantly shorter surgical time of lobectomy （（23.2 ± 5.1） minutes vs.（28.0 ± 5.0） minutes,t =4.156,P =0.000）.Negative results were seen in the time taking of creating surgical space （（14.6 ±3.3） minutes vs.（15.6 ±2.5） minutes）,central lymph node dissection （（25.1 ±5.4） minutes vs.（24.4 ±6.3） minutes） and total surgical time （（91.7 ± 11.4） minutes vs.（96.1 ± 13.0） minutes）.Conclusion Application of 3D technique in endoscopic surgery can offer 3D vision of the surgical field,thus significantly shorten lobectomy time and more easily to achieve fine dissection and functional protection of recurrent laryngeal nerves,parathyroids and other vital anatomic structures.