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疗效和安全性比较

Comparison of the efficacy and safety of anterior small incision approach and modified Miccoli endoscope assisted thyroidectomy in the treatment of benign thyroid tumor

目的分析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疗效和安全性。方法甲状腺良性肿瘤病人66例,根据手术方法的不同,将66例病人分成两组,观察组31例,行改良Miccoli腔镜辅助下手术;对照组35例,行颈前小切口入路手术。比较两组病人手术情况、美容满意度、术后6小时、12小时、24小时的视觉模拟评分(visual analogue scale,VAS)、术后并发症发生情况和声音障碍指数(voice handicap index,VHI)。结果 (1)观察组手术时间、住院时间和术中出血量分别为(44.68±23.30)分钟、(3.28±1.69)天和(43.57±23.73)m L,对照组分别为(59.43±30.61)分钟、(4.36±1.42)天和(59.43±30.61)m L,两组比较差异有统计学意义(P<0.05)。观察组和对照组的住院费用分别为(9.73±1.22)千元和(5.83±1.35)千元,两组比较差异有统计学意义(P<0.05);(2)观察组和对照组的美容满意度分别为96.8%和80.0%,两组比较差异有统计学意义(P<0.05);(3)观察组术后12小时、24小时的VAS评分分别为(3.11±0.55)分和(1.63±0.21)分,对照组分别为(4.17±0.73)分和(2.59±0.36)分,两组比较差异有统计学意义(P<0.05);(4)观察组术后并发症发生率为6.45%,对照组为11.43%;观察组术后VHI为(0.70±0.45)分,对照组为(0.65±0.39)分,两组比较差异无统计学意义(P>0.05)。结论对于甲状腺良性肿瘤病人,无论是采取改良Miccoli腔镜辅助下手术还是颈前小切口入路均安全有效,改良Miccoli腔镜辅助下手术手术时间和住院时间短、术中出血量少,美容效果好,但会增加住院费用。

Objective To compare and analyze the clinical efficacy and safety of anterior small incision approach and modified Miccoli endoscope assisted thyroidectomy in the treatment of benign thyroid tumor.Methods A total of 66 cases with benign thyroid tumor were enrolled in our hospital from April 2014 to April 2017,and divided into two groups according to different surgical methods.The 31 patients who underwent modified Miccoli endoscope assisted surgery was made as the observation group and the 35 patients who underwent anterior neck small incision approach was made as the control group.The operation,cosmetic satisfaction,visual analogue scale（VAS） at 6 hour,12 hour and 24 hour after operation,the incidence of postoperative complications and the voice handicap index（VHI） of the two groups were recorded and analyzed.Results（1）The operation time,hospitalization time,intraoperative blood loss in the observation group were（44.68 ± 23.30） mins,（3.28 ± 1.69） dsys and（43.57 ± 23.73） m L,respectively,which were lower than those [（59.43 ± 30.61） mins,（4.36 ± 1.42） days and（59.43 ±30.61） m L] in the control group（P〈0.05）.The hospitalization expense in the observation group was（9.73 ± 1.22） KRMB,which was higher than that[（5.83 ± 1.35） KRMB] in the control group（P〈0.05）.（2）The degree of cosmetic satisfaction in the observation group was 96.77%,which was significantly higher than 80% in control group（P〈0.05）.（3）The score of VAS at 12 hour and 24 hour in the observation group were（3.11 ± 0.55） and（1.63 ± 0.21） respectively,which were significantly lower than those[（4.17 ± 0.73） and（2.59 ± 0.36） ] in the control group（P〈0.05）.（4）The incidence of postoperative complications in the observation group was 6.45%,which was statistically insignificant when compared with that（11.43%） in the control group（P〉0.05）.（5）The VHI in the observation group was（0.70 ±0.45）,which was statistically insignificant when compared with that（0.65 ± 0.39） in the control group（P〉0.05）.Conclusion For patients with benign thyroid tumors,the modified Miccoli endoscope assisted surgery and anterior small incision approach are both safe and effective.The former has the advantages in shortening the operation time and hospitalization time,reducing the blood loss and promoting the cosmetic effect,but it may increase the hospitalization expenses.