锁骨上侧入路甲状腺切除术与腔镜手术治疗甲状腺效果比较

Comparative study of supraclavicular lateral approach and endoscopic approach for thyroidectomy

目的比较锁骨上侧入路甲状腺切除术与完全腔镜甲状腺切除术应用于甲状腺手术患者的临床效果。方法纳入2009年3月至2013年12月本院收治的167例需要施行甲状腺切除术的患者,根据病情结合患者意愿分为两组,分别采用锁骨上侧入路手术(n=99)和完全腔镜手术(n=68)。观察并比较两组患者手术时间、切口长度、术中出血量等各项指标,手术并发症发生情况,术后恢复及美容效果评价情况。结果 1两组患者术中失血量比较差异无统计学意义(P>0.05)。腔镜手术组切口长度明显短于侧入路手术组,但手术时间明显长于腔镜手术组,差异均有统计学意义(P<0.05);2侧入路手术组、腔镜手术组术后并发症发生率分别为2.02%、1.47%,差异无统计学意义(P>0.05);3锁骨上侧入路组、完全腔镜手术组术后平均住院时间分别为(5.4±1.1)d,(4.5±0.9)d,术后颈部外观满意度评分分别为(7.2±1.1)分,(8.7±0.7)分,差异均无统计学意义(P>0.05)。结论经锁骨上侧入路途径行甲状腺切除术是安全可行的,与腔镜手术相比,适应证扩大,手术时间缩短,美容效果尚属满意。

Objective To compare the clinical effect of supraclavicular lateral approach and endoscopic ap-proach for thyroidectomy. Methods A total of 167 patients with thyroid diseases who were admitted to our hospital from March 2009 to December 2013 were allocated to two groups according to patients＆#39; condition and willing：supraclavicular lateral approach group （n=99） and endoscopic approach group （n=68）. Surgery time, length of incision, intraoperative blood loss, incidence of complications, postoperative recovery and cosmetic result between two groups were compared. Results ①The difference between intraoperative blood loss of the two groups was not statistically significant （P〉0.05）. The length of incision in endoscopic approach group was significantly shorter than that in supraclavicular lateral approach group, while surgery time in endoscopic approach group was longer than that in supraclavicular lateral approach group. The differences were both statistically significant （P〈0.05）.②The incidence of complications were 2.02%, 1.47%respec-tively in supraclavicular lateral approach group and endoscopic approach group, and the difference was not statistically sig-nificant （P〉0.05）.③Mean length of stay in supraclavicular lateral approach group and endoscopic approach group were （5.4±1.1） days and （4.5±0.9） days respectively, and satisfactory scores of neck appearance were （7.2±1.1） and （8.7±0.7） re-spectively. Both of the differences were not statistically significant （P〉0.05）. Conclusion The supraclavicular lateral ap-proach is a safe and feasible approach for thyroidectomy. It holds the advantages of extensive indication, short surgery time and acceptable cosmetic result compared with endoscopic approach.