乳晕入路全腔镜下甲状腺癌根治术与小切口甲状腺癌根治术的临床对比分析

Clinical effective comparison and cosmetic result of thyroid cancer after minimally invasive video-assisted thyroidectomy versus totally endoscopic thyroidectomy

目的：对比全腔镜下甲状腺手术与小切口甲状腺手术治疗甲状腺癌的手术效果及美容效果。方法：将33例术前行甲状腺细针穿刺抽吸诊断为甲状腺乳头状癌的患者随机分为两组,其中16行乳晕入路腔镜下甲状腺癌根治术（腔镜组）,17例行腔镜辅助小切口甲状腺癌根治术（小切口组）。对比分析两组患者手术时间、淋巴结清扫数量、术后引流时间、术后并发症发生率、患者切口满意度等指标。结果：小切口组手术时间、术后引流时间均明显少于腔镜组（P〈0.05）;两组淋巴结清扫数量、术后并发症发生率差异无统计学意义（P〉0.05）;而腔镜组患者满意程度明显优于小切口组（P〈0.05）。结论：小切口甲状腺手术与腔镜甲状腺手术均属于美容手术,两者均具有良好的手术安全性及根治效果,小切口手术在手术时间、术后引流等方面优于腔镜手术,但颈部仍有2~3 cm的瘢痕。腔镜手术具有术后颈部无瘢痕的美容效果,美容效果更佳,但应严格掌握适应证。

Objective： The text compares the clinical effect and cosmetic result of endoscopic thyroidectomy（ ET） with minimally invasive video-assisted thyroidectomy（ MIVAT） for thyroid cancer. Methods： Thirty-three patients,who were diagnosed as thyroid papillary carcinoma by thyroid fine needle aspiration biopsy prior to operation,matched the inclusion criteria. They were randomly allotted to undergo MIVAT（ n = 17） or ET in areola approach（ n = 16）. Operative time,lymph node dissection,postoperative drainage time,complications and cosmetic result were evaluated. Results： In the MIVAT group operative time and drainage time were less than those in ET group（ P 〈 0. 05）,but there was no statistical difference in complications and lymph node dissection（ P 〉 0. 05）. The satisfaction scores were better in ET group than in MIVAT group. Conclusions： ET and MIVAT are cosmetic surgeries,which have been proven safe and effective. MIVAT has advantages over ET in operative time and drainage time. Whereas,ET seems to supersede MIVAT in terms of cosmetic outcome. MIVAT will leave 2-3 cm scar on neck,opposing to ET with no scar left. Indication of ET should be strictly matched.