腔镜甲状腺手术治疗甲状腺微小乳头状癌的疗效及体会

Efficacy and experience of endoscopic thyroidectomy for the treatment of papillary thyroid microcarcinoma

目的:总结经胸乳入路腔镜甲状腺手术治疗甲状腺微小乳头状癌的手术方法、术中要点及临床应用价值。方法:120例患者分别行经胸乳入路腔镜甲状腺手术(观察组,n=56)与开放甲状腺手术(对照组,n=64),评价两组手术时间、术中出血量、清扫淋巴结数量、术后24 h引流量、术后拔管时间、疼痛视觉模拟评分、美容满意度、术后住院时间、住院费用及并发症情况。结果:120例手术均获成功,两组清扫淋巴结数量、术后拔管时间、术后住院时间、并发症情况及暂时性喉返神经麻痹、暂时性甲状旁腺功能减退发生率差异无统计学意义(P>0.05);观察组术中出血量、术后24 h引流量、疼痛视觉模拟评分、美容满意度均优于对照组,但对照组手术时间、住院费用优于观察组,差异有统计学意义(P<0.05)。结论:严格把握手术适应证,对于甲状腺微小乳头状癌患者,腔镜手术与开放手术具有相同的手术安全性、有效性及彻底性,但腔镜手术具有操作精细、术后疼痛轻、美容效果好的优点,是较佳的治疗术式。

Objective:To explore and summarize the methods,key points and clinical application value of endoscopic thyroidectomy via breast approach for the treatment of papillary thyroid microcarcinoma.Methods:One hundred and twenty patients with papillary thyroid microcarcinoma were divided into the scarless endoscopic thyroidectomy(SET)group(n=56)and the traditional open thyroidectomy(TOT)group(n=64),and the two groups were assessed regarding the operative time,intraoperative blood loss,number of lymph node dissection,postoperative 24 h drainage,postoperative extubation time,pain score,cosmetic satisfaction,postoperative hospital stay,total hospitalization expenses and postoperative complications.Results:The operation was successfully completed in 120 patients.There was no statistically significant difference in the number of lymph node dissection,extubation time,postoperative hospital stay,complications,temporary recurrent laryngeal nerve paralysis and temporary hypoparathyroidism between the two groups(P >0.05).The amount of bleeding during operation,postoperative 24 h drainage,pain score and cosmetic satisfaction in the SET group were all better than those in the TOT group.However,the SET group was at a disadvantage in terms of operation time and hospitalization expenses,and the differences were statistically significant(P<0.05).Conclusions:Under the condition of strict grasping the indications of surgery,endoscopic surgery and open surgery have the same safety,effectiveness and thoroughness for papillary thyroid microcarcinoma patients.In addition,endoscopic surgery has the advantages of fine operation,light postoperative pain,good cosmetic effect,and is a better surgical treatment scheme.