颈前小切口入路与改良Miccoli腔镜辅助下手术治疗甲状腺良性肿瘤的临床研究

Clinical study of small incision approach to anterior cervical and surgical goiter treatment for benign thyroid tumor with the assistance of modified Miccoli endoscope

目的探究颈前小切口入路甲状腺手术、改良Miccoli腔镜辅助下甲状腺手术对甲状腺良性肿瘤治疗的效果差异。方法回顾性分析2012年9月至2014年8月期间本院收治的确诊的84例甲状腺良性肿瘤患者的临床资料,根据手术方式分为颈前小切口组(n=42)和改良Miccoli腔镜辅助下甲状腺手术组(n=42),分别就两组的手术时长、住院时间、住院费用、术后颈部引流量、美容满意度及并发症发生率进行比较。结果与颈前小切口组相比,改良Miccoli组患者手术时间更短[(63.6±15.5)分钟vs(93.2±20.3)分钟],美容满意度[(4.3±0.2)分vs(3.6±0.1)分]与住院费用[(9764.7±1050.8)元vs(5941.6±1233.3)元]则均较高,两组比较差异均具有显著性(P<0.05);在住院时间与术后颈部引流量方面,组间比较差异均无显著性(P>0.05);颈前小切口组与改良Miccoli组分别有2例和1例患者在术后发生了喉返神经损伤即声音嘶哑,分别于术后约1个月和3个月行喉镜检查恢复,两组比较差异无显著性(P=0.572)。未发生其他手术并发症。结论颈前小切口入路手术与改良Miccoli腔镜辅助下手术治疗甲状腺良性肿瘤均可达到常规手术的切口切除范围,二者并发症也和传统手术相当,且两种手术方式均能完全切除肿瘤;改良Miccoli腔镜辅助下手术较颈前小切口入路手术的颈部美容效果更好,但住院费用明显高于后者。

Objective To explore differences of efficacy between small incision approach to anterior cervical in the thyroid surgery and thyroid surgery for the treatment of benign thyroid tumors with the assistance of modified Miccoli endoscopic. Method The clinical study was conducted through for which 84 cases of patients with benign neoplasm of thyroid gland in our hospital were selected from September 2012 to August 2014. The patients were divided into two groups, the small incision approach to anterior cervical group （n=42） and the modified Miccoli group （n=42）. The comparison between the two groups was according to the time of operation, the volume of drainage after operation, the degree of cosmetology satisfaction, the occurrence rate of complication, hospital stays and hospitalization expenses, Result Compared with the small incision approach to anterior cervical group, the operation time was shorter in the modified Miccoli group [（63.6 4-15.5） rain vs （93.2___ 20.3） min]. The degree of satisfaction[（4.3 ___ 0.2） scores vs （3.6 ~ 0.1） scores] and the hospitalization expenses [（9764.7 4-1050.8） yuan vs （5941.6 4-1233.3） yuan] are both high. It meant the differences of the comparison were statistically significant, P〈0.05. There were no statistical significance in the differences between the two groups researching the volume of drainage after operation and hospital stays, P〉0.05. There were 2 cases in the first group and 1 case in the later occurring recurrent laryngeal nerve injury （hoarseness）, which recovered in 1 months and 3 months after surgery. The difference was not statistically significant （P=0.572）. More, no other operative complications occurred. Conclusion Both small incision approach to anterior cervical in the surgery and surgery of benign thyroid tumor therapy with the assistance of modified Miccoli endoscopic can achieve conventional surgical incision resection, and the complications of them are similar to the traditional surgery. Moreover, both two kinds of operation can complete resection of the tumor; surgery with the assistance of modified Miecoli cavity endoscope has better cosmetic results of neck than surgery by small incision approach to anterior cervical. The former hospitalization cost was apparently higher than that of the latter.