经乳晕径路腔镜甲状腺手术与传统开放性手术对甲状腺良性结节患者创伤影响比较

Comparision of influences about the trauma in the treatment of benign thyroid nodules by Thyroid endoscopic thyroidectomy and open thyroidectomy

目的比较经乳晕径路腔镜甲状腺手术与传统开放性手术对甲状腺良性结节手术创伤影响,为临床治疗提供参考。方法回顾分析2013年1月~2014年8月本院接诊的甲状腺良性结节患者的临床病例资料,根据入组标准共计纳入90例患者,按治疗方法不同分为观察组45例和对照组45例,观察组患者采用经乳晕径路腔镜甲状腺手术治疗,对照组患者采用传统开放性手术治疗,记录两组患者术中失血量、术后引流量、拔管时间、住院时间,进行术后1d和2d疼痛VAS评分,出院后随访2个月,进行美容效果的满意度和SF-36生活质量调查。结果观察组术中失血量、拔管时间、术后1d和2d疼痛VAS评分、术后引流量、住院时间均明显低于对照组（t=8.237、3.614、3.202、3.339、9.253、3.552,P〈0.05）。观察组随访2个月后的手术满意率为97.78%,明显高于对照组51.11%（x2=25.756,P〈0.05）;观察组的SF-36综合评分明显高于对照组（t=8.460,P〈0.05）。对照组并发症发生率为22.22%,观察组为8.89%,差异具有统计学意义（x2=4.406,P〈0.05）。结论经乳晕径路腔镜甲状腺手术可具备达到开放手术的治疗效果,且具有创伤小、美容效果好、疼痛轻、安全性好的优点,值得临床推广。

Objective To compare the influences about the trauma in the treatment of benign thyroid nodules by Thyroid endoscopic thyroidectomy and open thyroidectomy, to provide reference for clinical treatment. Methods the clinical data of 90 patients from January 2013 to August 2014 in our hospital were collected for mading a retrospective analysis,all patients were met Inclusion criteria,whicn were divided into two groups,45 cases of cach group,the observation group were given Thyroid endoscopic thyroidectomy,the control group were given open thyroidectomy,the intraoperative blood loss, postoperative drainage, extubation time, hospital stay time were recorded,the vas score were evaluated for assessing pain in the first day and the second day postoperative,all the patients had been follow up for two month after leave hospital,and patients＇ satisfaction of cosmetic effect and quality of life scale statistics were collected from SF-36 scale. Results the intraoperative blood loss,extubation time,VAS scores on 1d and 2d postoperative, postoperative drainage,hospital stay time of the observation group were significantly lower than the control group（t=8.237、3.614、3.202、3.339、9.253、3.552,P 0.05）.After 2 months＇ following-up,the rate of surgery satisfaction of the observation group were 97.78%,which were significantly higher than the control group（51.11%）,（x2=25.756,P 0.05）;the SF-36 composite score of the observation group were significantly higher than the the control group（t=8.460,P 0.05）.the complication rate of the control group was 22.22%,the observation group was 8.89%, the difference was statistically significant（x2=4.406,P 0.05）. Conclusion the thyroid endoscopic thyroidectomy has the same effect with open thyroidectomy,but has less trauma,better cosmetic results, less pain, good security for postoperative patients,is worthy to be clinical popularized and applied.