高原地区与非高原地区胸乳路径腔镜甲状腺手术的对比研究

Comparison of breast approach endoscopic thyroidectomy between the high altitude and low altitude area

目的:对比研究高原地区与非高原地区患者经胸乳路径行腔镜甲状腺手术的临床疗效。方法:回顾分析2015年1月至2016年4月收治的长期生活在青海高原地区的患者(高原组,n=25)与非高原地区患者(非高原组,n=28)的临床资料,为两组患者行胸乳路径腔镜甲状腺手术,对比两组患者术前合并症、手术时间、术中出血量、术后引流量、拔管时间、住院时间、术后并发症及切口满意度等情况。结果:两组手术均获成功,无一例中转开放。术前高原组患者合并高原红细胞增多症及凝血功能异常发生率高于非高原组(P<0.05)。高原组术中出血量较多[(42.60±6.37)ml vs.(13.39±4.73)ml,t=19.09,P=0.00]、手术时间较长[(126.88±22.73)min vs.(98.93±11.17)min,t=5.58,P=0.00]。两组住院时间、术后引流量、拔管时间、术后并发症及切口满意度相比差异均无统计学意义(P>0.05)。结论:高原地区患者手术时间较非高原地区患者长、术中出血量较多,但手术均顺利完成,术后并发症无明显差异,提示腔镜甲状腺手术对高原地区患者亦是安全的。

Objective： To compare the clinical efficacy of breast approach endoscopic thyroidectomy between the high altitude and low altitude area. Methods： The clinical data of 25 patients who long lived in high altitude area and 28 patients lived in low altitude area from Jan. 2015 to Apr. 2016 were retrospectively analyzed. All patients underwent endoscopic thyroidectomy in breast approach. The preoperative complications,operation time,intraoperative blood loss,postoperative drainage volume,removal time of drainage tube,hospital stay,postoperative complications and cosmetic results of incision were compared and analyzed between the 2 groups. Results： All53 operations were successfully completed without conversion to conventional procedure. The incidence of high altitude polycythemia and abnormal coagulation function in high altitude group was higher than that in low altitude group（ P 〈 0. 05）. Intraoperative blood loss was significantly more in high altitude group than that in low altitude group [（ 42. 60 ± 6. 37） ml vs.（ 13. 39 ± 4. 73） ml,t = 19. 09,P= 0. 00]. Operation time in high altitude group was longer than low altitude group [（ 126. 88 ± 22. 73） min vs.（ 98. 93 ± 11. 17） min,t = 5. 58,P = 0. 00]. However,there were no significant differences between the two groups in hospital stay,postoperative drainage volume,removal time of drainage tube,postoperative complications and cosmetic results of incision（ P 〉 0. 05）. Conclusions： Compared with the patients living in low altitude area,the patients in high altitude area has longer operation time and more intraoperative blood loss,but all operations are successful without increased postoperative complications,it indicates that endoscopic thyroidectomy can be applied in high altitude area safely.