3D腹腔镜辅助甲状腺癌颈侧淋巴清扫术的临床随机对照研究

A clinical study of 3-D laparoscopic assisted selective neck dissection for thyroid carcinoma

目的 探究传统开放手术及2D、3D腹腔镜辅助甲状腺癌颈侧淋巴清扫术的临床价值。方法回顾性分析2015年10月至2017年12月120例进行甲状腺癌根治术患者的临床资料,依据手术方式分为开放组、2D组及3D组各40例。采用SPSS21.0统计软件包分析数据,术中术后指标、VAS评分等用(x±s)表示,两组间采用t检验,三组间采用方差齐性检验;治疗满意率和术后不良反应情况采用χ^2检验。P<0.05表示差异有统计学意义。结果2D、3D组手术时间长于传统开放组;3D腹腔镜组术中出血量、术后24h内引流量较2D组、传统组少(P<0.05);三组间淋巴结清扫数、术后住院时间、总出院时间差异无统计学意义(P>0.05);3D组并发症发生率7.5%,显著低于2D腹组15.0%与开放组32.5%(P<0.05);术后24h疼痛评估及患者满意度均明显优于其他两组(P<0.05)。结论3D腹腔镜辅助甲状腺癌颈侧淋巴清扫术临床应用安全可靠,值得进一步推广。

Objective To compare conventional open surgery and 2D and 3D assisted laparoscopic neck dissection for thyroid cancer. Methods The clinical data of 120 patients undergoing radical thyroidectomy from October 2015 to December 2017 were retrospectively analyzed. According to the surgical approach, they were divided into open group, 2D group, and 3D group, each 40 cases. The SPSS 21.0 statistical software package was used to analyze. The intraoperative and postoperative data and VAS scores were expressed as mean±standard deviation (x±s), and compared with t test. Satisfaction rate of treatment and postoperative adverse reactions were compared by χ^2 . P <0.05 indicated that the difference was statistically significant. Results The operation time was longer in the 2D and 3D groups than in the traditional open group. The blood loss in the 3D laparoscopic group and the drainage volume within 24 hours after the operation were lower than those in the 2D group and the traditional group ( P <0.05). There was no significant difference in the number of lymph node dissected and postoperative hospital stay and total discharge time among the three groups ( P >0.05). The incidence of adverse reactions in the 3D group was significantly lower than that in the 2D abdominal group and the traditional group7.5% vs. 15% and 32.5%. The postoperative pain assessment at 24h and degree of satisfaction in 2D, 3D laparoscopic group were significantly better than those in open group ( P <0.05). Conclusion The clinical application of 3D assisted laparoscopic neck dissection for thyroid cancer is safe and reliable, and is worthy of further promotion .