经腋窝入路单孔腔镜手术治疗甲状腺肿瘤的疗效及安全性

Curative effect and safety of single-hole transaxillary endoscopic thyroidectomy in the treatment of thyroid tumor

目的探讨经腋窝入路单孔腔镜手术治疗甲状腺肿瘤的疗效和安全性。方法 130例甲状腺肿瘤患者,随机分为观察组和对照组各65例,观察组采用经腋窝入路单孔腔镜手术,对照组采用传统甲状腺手术,比较2组手术时间、术中出血量、术后住院时间、术后24、48h视觉模拟量表评分及术后1个月并发症发生情况。结果观察组患者术中出血量[(23.09±10.20)mL]、术后住院时间[(4.33±1.24)d]、术后24、48h视觉模拟评分[(3.82±1.02)、(2.79±0.82)分]均低于对照组[(38.13±12.94)mL、(6.22±0.98)d、(5.42±1.44)分、(3.88±1.07)分](P<0.05),手术时间[(170.35±20.51)min]与对照组[(165.33±19.40)min]比较差异无统计学意义(P>0.05);术后1个月,观察组发生皮下气肿1例,低钙血症1例,甲状旁腺功能低下1例;对照组发生皮下气肿3例,喉返神经损伤1例,低钙血症4例,甲状旁腺功能低下4例;观察组术后1个月并发症发生率(4.6%)明显低于对照组(18.5%)(P<0.05)。结论经腋窝入路单孔腔镜手术在甲状腺肿瘤患者中的应用具有较高可行性,可减轻疼痛,加快康复,降低术后并发症发生率。

Objective To investigate the curative effect and safety of single-hole transaxillary endoscopic thyroidectomy in the treatment of thyroid tumor. Methods Totally 130 patients with thyroid tumor were randomly divided into observation group and control group, with 65 patients in each group. Observation group underwent single-hole transaxillary endoscopic thyroidectomy and control group underwent conventional open thyroidectomy. The operation lasting time, intraoperative blood loss, hospitalization stay, postoperative 24- and 48-h visual analogue score, and postoperative 1-month complication rate were compared between two groups. Results The intraoperative blood loss （（23.09±10. 20） mL） was significantly less, postoperative hospitalization stay （（4. 33±1. 24） d） was significantly shorter, and postoperative 24- and 48-h visual analogue scores （3.82 ± 1.02, 2.79 ± 0.82） were significantly lower in observation group than those in control group （（38.13±12.94） mL, （6.22±0.98） d, 5.42±1.44, 3.88±1.07） （P〈 0.05）, and there was no significant difference in the operation lasting time between observation group （（170.35±20.51） rain） and control group （（165. 33±19. 40） min） （P〉0.05）. The complications in 1 month after operation included subcutaneous emphysema in 1 patient, hypocalcemia in 1 and hypoparathyroidism in 1 in observation group, while subcutaneous emphysema in 3 patients, recurrent laryngeal nerve injury in 1, hypocalcemia in 4, and hypoparathyroidism in 4 in control group. The postoperative 1-month complication rate was significantly lower in observation group （4.6%） than that in control group （18.5%） （P〈0.05）. Conclusion The single-hole transaxillary endoscopic thyroidectomy has a good feasibility, and it can promote the rehabilitation, relieve pain, and reduce the complication rate in the treatment of thyroid tumor.