胸乳入路腔镜甲状腺良性肿瘤切除与传统手术的临床对比

Comparative study of endoscopic thyroidectomy by breast approach and open thyroidectomy

目的:探讨经双侧胸乳入路腔镜手术治疗甲状腺良性肿瘤的手术疗效与优势。方法:回顾分析2013年8月至2014年8月为46例患者(观察组)行双侧胸乳入路腔镜甲状腺次全切除术的临床资料,并与同期60例(对照组)行开放式甲状腺良性肿瘤切除术的患者进行对比。比较两组手术时间、术中出血量、引流时间、引流量、术后并发症及患者对美容效果的满意度;两组患者分别于术前及术后6 h应用ELISA方法检测血清IL-6、TNF-α水平。结果:两组患者的术中出血量、引流时间、住院时间差异无统计学意义(P>0.05);与对照组相比,观察组手术时间较长,术后引流量较多,术后IL-6、TNF-α水平明显低于对照组,术后美容效果满意度高于对照组(P<0.05)。观察组患者无神经、血管损伤,对照组发生声音嘶哑及饮水呛咳各1例。结论:经双侧胸乳入路腔镜甲状腺次全切除术术后住院时间短,损伤小,美容效果明显优于开放手术。

Objective： To explore the operation curative effect and advantage of endoscopic thyroidectomy via anterior chest wall approach in the treatment of benign thyroid pathological changes. Methods： The clinical data of 46 patients of benign thyroid pathological changes who received endoscopic thyroidectomy via anterior chest wall approach（ endoscopic group） and 60 patients who received conventional open surgery（ control group） were retrospectively analyzed. The operative time,hemorrhage volume,drainage time,drainage volume,postoperative serum IL-6 and TNF-α,postoperative complications and cosmetic results were compared. The serum IL-6 and TNF-α were tested before operation and in 6 h after operation by ELISA. Results： There were no obvious differences between the two groups in intraoperative bleeding,drainage time and hospital stay（ P〈0. 05）. Endoscopic group resulted in a longer operative time and more postoperative drainage than control group（ P〈0. 05）. The level of IL-6 and TNF-α in endoscopic group were significantly lower than those in control group（ P〈0. 05）. The cosmetic results of endoscopic group were much better than those of control group,the difference was statistically significant（ P〈0. 05）. There was no nerve or vessel injury in endoscopic group. In control group,hoarseness occurred in 1 case and cough after drinking in another. Conclusions： Endoscopic thyroidectomy via anterior chest wall approach is safe and feasible in the treatment of benign thyroid pathological changes with shorter hospital stay,fewer operation wound and better cosmetic results than open operation.