腔镜双叶甲状腺次全切除术的临床应用

Application of endoscopic subtotal thyroidectomy for bilateral thyroid diseases

目的:探讨腔镜双叶甲状腺次全切除术的安全性与可行性。方法:收集2012年1月至2014年6月经胸乳入路行腔镜双叶甲状腺次全切除术(腔镜组,n=36)的临床资料,记录患者的一般资料及围手术期相关指标,并与同期施行的开放双叶甲状腺次全切除术(开放组,n=50)进行对比分析。结果:与开放组相比,腔镜组患者年轻[(43.86±13.15)岁vs.(51.86±11.97)岁,P=0.004]、住院时间短[(8.78±1.66)d vs.(11.62±5.78)d,P=0.005],但术后创面总引流量[120(90,154.50)ml vs.49.5(29.5,73.25)ml,P=0.000]及住院费用[9 447.10(8 659.19,11 687.55)元vs.8 157.38(6 900.88,10 007.19)元,P=0.002]均较开放组多,手术时间[(115.97±23.57)min vs.(105.68±26.61)min]、术中出血量[30(20,38.75)ml vs.20(13.75,31.25)ml,P=0.077]及并发症发生率(4/36 vs.1/50,P=0.189)两组差异无统计学意义。腔镜组患者对颈部美容效果满意。结论:腔镜双叶甲状腺次全切除术是安全、可行的,颈部美容效果好,在年轻女性患者中具有广阔需求,但术后引流量及费用较传统开放手术多。

Objective：To assess the safety and efficacy of endoscopic subtotal thyroidectomy （ET） for bilateral thyroid disea- ses. Methods ：This study performed a retrospective review of the patients who were performed ET via breast approach for bilateral thy- roid diseases （ET group, n = 36） from Jan. 2012 to Jun. 2014, and rendered the cases of open subtotal thyroidectomy for bilateral thy- roid diseases （OT group, n = 50） at the same period as control group. Comparison between the two groups in perioperative details and follow-up was reviewed. Results：Compared with OT group, the patients in ET group were younger [ （43.86 ± 13.15 ） years vs. （51.86 ±11.97） years, P = 0. 004], associated with more amount of postoperative drainage [ 120 （90,154.50） ml vs. 49.5 （29.5, 73.25 0. 002 23.57 0.077 ml,P = 0.000 ] and hospital cost [ 9 447.10 （8 659.19,11 687.55） yuan vs. 8 157.38 （6 900.88,10 007.19） yuan, P = but shorter hospital stay [ （8.78 ± 1.66） d vs. （ 11.62 ±5.78 ） d, P = 0. 005 ]. Differences of operating time [ （ 115.97 ± min vs. （ 105.68 ± 26.61 ） min ], intraoperative estimated blood loss [ 30 （ 20,38.75 ） ml vs. 20 （ 13.75,31.25 ） ml, P = and postoperative complications （4/36 vs. 1/50,P = 0. 189） between the two groups were not significant. All patients in ET group were satisfied with their excellent overall cosmetic results and the surgical outcome of the procedure. Conclusions： ET is a safe and feasible procedure for bilateral thyroid disease with a good prognosis and eosmesis but associated with more amount of postoperative drainage and more hospital cost. ET is a popular procedure for young female patients with thyroid disease.