经腋窝入路与经胸乳入路腔镜甲状腺切除术的对比研究

A Comparative Study of Axillary Approach Versus Breast Approach for Endoscopic Thyroidectomy

目的比较经腋窝入路与经胸乳入路腔镜甲状腺切除术的临床应用价值。方法我院2013年1月~2016年1月手术治疗201例单侧甲状腺良性疾病,根据患者意愿,其中96例采用经腋窝入路,105例采用经胸乳入路,术中均不常规显露喉返神经。比较2组手术时间、出血量、引流量、住院时间、术后并发症。结果手术均获成功。与经胸乳组相比,经腋窝组手术时间短[(56.9±13.6)min vs.(71.4±11.3)min,t=-8.258,P=0.000],术中出血少[(14.0±8.5)ml vs.(21.0±12.5)ml,t=-4.553,P=0.000],术后引流少[(33.5±14.4)ml vs.(51.1±22.0)ml,t=-6.630,P=0.000]。2组住院时间差异无显著性[(5.3±0.9)d vs.(5.4±1.1)d,t=-0.475,P=0.635]。2组均无喉返神经损伤及甲状旁腺损伤等并发症。结论经腋窝及胸乳入路的腔镜甲状腺切除术是一种安全可行的方法,但经腋窝入路创伤程度及手术时间优于经胸乳入路。

Objective To compare the clinical value of axillary approach and breast approach for endoscopic thyroidectomy.Methods From January 2013 to January 2016,201 patients with unilateral thyroid benign disease were divided into two groups according to the patient＇s wishes,either receiving endoscopic thyroidectomy through axillary approach（ 96 cases） or breast approach（ 105 cases）. The recurrent laryngeal nerve did not routinely display in both procedures. The operative time,blood loss,drainage volume,hospital stay and postoperative complications were compared between the two groups. Results All the procedures were accomplished successfully. Compared with the breast group,the axillary group had shorter operation time [（ 56. 9 ± 13. 6） min vs.（ 71. 4 ± 11. 3） min,t =-8. 258,P = 0. 000],less intraoperative blood loss [（ 14. 0 ± 8. 5） ml vs.（ 21. 0 ± 12. 5） ml,t =-4. 553,P = 0. 000） ],and less postoperative drainage [（ 33. 5 ± 14. 4） ml vs.（ 51. 1 ± 22. 0） ml,t =-6. 630,P = 0. 000].There was no significant difference in hospitalization time between the two groups [（ 5. 3 ± 0. 9） d vs.（ 5. 4 ± 1. 1） d,t =-0. 475,P = 0. 635]. There were no severe complications such as injury of the recurrent laryngeal nerve or parathyroid gland in both groups.Conclusion Both procedures for endoscopic thyroidectomy are safe and effective,and the axillary approach is superior to breast approach in surgical trauma and operation time.