全腔镜下甲状腺癌根治术与传统开放性手术的临床效果比较

Clinical effective comparison of radical operation of thyroid cancer under whole endoscope and traditional open surgery

目的对比研究全腔镜下甲状腺癌根治术与传统开放性手术的术中及术后的临床效果。方法收集2014-2015年新疆医科大学附属肿瘤医院乳腺头颈外科收治的甲状腺癌病例共计100例,随机分为实验组和对照组每组50例,实验组实行经胸-乳入路、跨锁骨入路联合的甲状腺癌根治术,对照组给予传统颈前切口行甲状腺癌根治术,治疗后随访并统计两组治疗疗效、不良反应发生和术后并发症。结果实验组中患者术中出血量、术后引流量、住院时间,术后24h疼痛评分、总不良反应(吞咽困难、呼吸困难、出血、感染)发生率、术后并发症(声音嘶哑、暂时性低钙、手足麻木、发音困难)总发生率等均较对照组低,手术时间与对照组比较差异无统计学意义(138.5±17.6和145.2±18.9,P>0.05)。结论经胸乳入路、锁骨上联合的甲状腺癌根治术较传统开放性手术相比,具有术中出血量少、术后引流量少、住院时间短、不良反应及并发症总体发生率低等优点,并且具有颈部无疤痕遗留的美容效果,值得临床推广,但要严格掌握手术适应证。

Objective To compare the intraoperative and postoperative effects of radical operation of thyroid cancer and traditional open surgery.Methods 100 cases collected from the Department of Breast,Head and Neck Surgery,the Affiliated Tumor Hospital,Xinjiang Medical University during 2014-2015 were randomly divided into experimental group and control group（50cases for each）.The experimental group was treated with radical operation of thyroid cancer by Breast approach combining with supraclavicular approach under whole endoscope,while the control group was treated with radical operation by traditional cervical incision,then follow-up visit and collected data curative effect,adverse reaction and the postoperative complications to analyze.Results In the experimental group patients intraoperative blood loss,postoperative drainage volume,hospital staying,postoperative pain score,24 htotal incidence of adverse reactions（difficulty swallowing or breathing difficulties,bleeding and infection）,and the total incidence of postoperative complications（hoarseness,temporary low calcium and extremities numbness,pronouncing difficulties）were lower than that in control group,but with no statistical difference（138.5±17.6and145.2±18.9,P〈0.05）.Conclusion Breast approach and supraclavicular joint radical operation for thyroid cancer had more advantages than traditional open surgery in aspects of less intraoperative blood loss,less postoperative drainage volume,shortening hospitalization staying,lower total incidence of adverse reactions and complications,and with no scar-left cosmetic effect of neck,thus which is worth generalizing,but need to command the operation indications strictly.