不同显露方法在腔镜甲状腺手术中的临床应用分析

Comparison of different methods of exposure in endoscopic thyroid surgery

目的:探讨不同显露方法在腔镜甲状腺手术中的临床应用。方法:回顾分析63例甲状腺肿块位于侧后方的患者经胸乳入路行非颈部切口腔镜甲状腺切除术的临床资料,其中12例行常规腔镜甲状腺手术(A组),22例行缝合颈前肌群显露法腔镜甲状腺手术(B组),29例应用甲状腺专用拉钩行腔镜甲状腺手术(C组)。结果:3组手术均获成功,无一例中转开放手术,均未损伤甲状旁腺。C组较A、B组手术时间短、出血少,差异有统计学意义(P<0.05);术后并发症发生率、住院时间及随访患者满意度3组差异无统计学意义(P>0.05)。结论:三种显露方法美容优势明显,对于甲状腺肿块位置较深、常规显露困难的患者,将甲状腺专用拉钩应用于非颈部切口腔镜甲状腺手术中疗效满意,与常规手术、缝合颈前肌群显露法相比,可更好地显露手术视野,降低手术难度,具有较广阔的应用前景。

Objective： To investigate the clinical values of different exposure methods in endoscopic thyroid surgery. Methods： A retrospective study was performed on the clinical data of 86 patients with endoscopic thyroidectomy through anterior chest and breast approach. 63 patients of them with a thyroid tumor located at the rear side were included for further analysis. 12 patients underwent con- ventional endoscopic thyroidectomy （group A） ,22 patients underwent endoscopic thyroidectomy with exposure methods of suturing ante- rior cervical muscles （ group B） , and the last group included 29 patients who underwent endoscopic thyroidectomy using endoscopic thy- roid retractor （group C）. Results：All endoscopic thyroidectomies were performed successfully without conversion to open operation. No case with injury of parathyroid gland was observed. Compared with Group A and B, Group C showed more advantages in operative time and blood loss （ P 〈 0.05 ）. There was no significant difference among group A, B, and C in the incidence of postoperative complica- tions, hospital stay, and patient satisfaction （ P 〉 0.05 ）. Conclusions ： All of the three exposure methods have advantages in cosmetic effect. However, for the tumors located at the rear side, or tumors with difficult exposure, application of endoscopic thyroid retractor reduces the difficulty of the operations effectively, and provides more clearly visual field for surgeons compared with exposure methods of conventional endoscopic thyroidectomy and suturing anterior cervical muscles. The endoscopic thyroid retractor will be used more widely in the future.