小空间腔镜甲状腺切除术的应用研究

Application Research of Small Space Endoscopic Thyroidectomy

目的探讨小空间腔镜甲状腺切除术的安全性和可行性。方法选择2016年1月~2017年12月在我院手术的女性良性甲状腺结节60例,随机分为2组。常规组30例,采用常规胸乳入路腔镜甲状腺切除手术;小空间组30例,行小空间腔镜甲状腺切除手术,采用加长trocar(总长20cm)穿至胸骨上窝,颈前皮下间隙分离上至甲状软骨喉结水平,下至胸骨上窝,左右至胸锁乳突肌前缘,建立手术操作空间。比较2组手术时间、出血量、引流时间、引流量、住院时间、疼痛评分、美容满意度以及并发症等。结果与常规组相比,小空间组引流量少[(69.2±20.7)mlvs.(85.7±37.8)ml,t=-2.076,P=0.042],引流时间短[(2.1±0.5)dvs.(2.5±0.7)d,t=-2.840,P=0.006],术后住院时间短[(3.4±0.6)dvs.(3.8±0.6)d,t=-2.396,P=0.020],术后1天疼痛轻[(2.9±1.0)分vs.(4.1±0.9)分,t=-4.679,P=0.000],并发症发生率低[3.4%(1/29)vs.30.0%(9/30),χ^2=7.385,P=0.007];而2组手术时间、出血量、美容满意度无统计学差异(P>0.05)。所有患者均门诊随访1年,无甲状腺功能减退及结节再发。结论小空间腔镜甲状腺切除术具有创伤小、恢复快、疼痛轻、并发症少、美容效果好等优点,有广阔的应用前景。

Objective To study the safety and practicability of small space endoscopic thyroidectomy.Methods Sixty female patients with benign thyroid nodules in our hospital from January 2016 to December 2017 were randomly divided into two groups.Thirty cases in the control group were given conventional endoscopic thyroidectomy via axillo-breast approach,and thirty cases in the experimental group were given small space endoscopic thyroidectomy.In the experimental group the extended trocars (total length,20 cm) were punctured into superior sternal fossa to establish the operative space in anterior cervical subcutaneous space,upper to the level of thyroid cartilage laryngeal junction,lower to the superior sternal fossa,left and right to the anterior edge of sternocleidomastoid muscle.The bleeding volume,operation time,drainage time,drainage volume,hospitalization time,pain scores,cosmetic satisfaction and complications were compared between the two groups.Results As compared to the control group,the experimental group had significantly less postoperative drainage [(69.2±20.7) ml vs.(85.7±37.8) ml,t =-2.076,P =0.042],shorter time of drainage [(2.1±0.5) d vs.(2.5±0.7) d,t =-2.840,P =0.006],shorter postoperative hospital stay [(3.4±0.6) d vs.(3.8±0.6) d,t =-2.396,P =0.020],better pain score [(2.9±1.0) vs.(4.1±0.9) points,t =-4.679,P =0.000] and less incidence of complications [3.4%(1/29) vs.30.0%(9/30),χ^2 =7.385,P =0.007].There were no significant differences between the two groups in operation time,bleeding volume,and cosmetic satisfaction(P>0.05).There was neither hypothyroidism nor recurrence of nodules in both groups during one-year follow-up period.Conclusion Small space endoscopic thyroidectomy has advantages of less trauma,fast recovery,less pain,less complication and good cosmetic effects,having broad application potential.