腔镜Dunhill术式治疗甲状腺功能亢进的临床应用

Clinical Application of Endoscopic Dunhill Operation in the Treatment of Hyperthyroidism

目的探讨胸乳入路腔镜Dunhill术式治疗甲状腺功能亢进(甲亢)的效果。方法回顾分析我科2010年1月~2018年12月采用Dunhill术式治疗41例甲亢,根据患者意愿选择术式,腔镜Dunhill术式18例(腔镜组),开放Dunhill术式23例(开放组)。比较2组手术时间、术中出血量、术后24 h引流量、住院时间、住院费用、术后并发症、术后1个月甲状腺功能等指标。结果41例手术均成功完成,腔镜组与开放组住院时间、术后1个月甲状腺功能(TSH、FT3、FT4)及并发症比较,差异无统计学意义(P>0.05),但腔镜组住院费用明显高于开放组[(18349.22±938.07)元vs.(15929.13±875.45)元,t=8.514,P=0.000],手术时间明显长于开放组[(171.3±5.2)min vs.(163.5±7.9)min,t=3.637,P=0.001],术中出血量[(28.7±9.7)ml vs.(37.3±7.8)ml,t=-3.146,P=0.003]、术后24 h引流量[(44.1±10.8)ml vs.(58.0±15.0)ml,t=-3.317,P=0.002]明显少于开放组。结论胸乳入路腔镜Dunhill术式治疗甲亢是安全、有效、可行的,有一定的美容效果的方法。

Objective To study the efficacy of endoscopic Dunhill operation in the treatment of hyperthyroidism.Methods A total of 41 patients with hyperthyroidism in our hospital from January 2010 to December 2018 were divided into the endoscopic surgery group(n=18)and the open surgery group(n=23)according to the willingness of the patients.Patients in the endoscopic surgery group underwent endoscopic thyroidectomy by Dunhill approach,while patients in the open surgery group underwent open thyroidectomy by Dunhill approach.The operation time,intraoperative bleeding volume,postoperative 24-hour drainage volume,hospitalization time,hospitalization cost,postoperative complications and thyroid function were compared between the two groups.Results The operations were successful in all the 41 patients.There were no statistically significant differences between the two groups in hospital stays,hormone levels(TSH,FT3,FT4)in the first month after surgery and complications(P>0.05).The cost of hospitalization in the endoscopic group was significantly higher than that in the open group[(18349.22±938.07)yuan vs.(15929.13±875.45)yuan,t=8.514,P=0.000].The operation time was significantly longer than that in the open group[(171.3±5.2)min vs.(163.5±7.9)min,t=3.637,P=0.001].The amount of bleeding during the operation[(28.7±9.7)ml vs.(37.3±7.8)ml,t=-3.146,P=0.003]and the volume of postoperative 24-hour drainage[(44.1±10.8)ml vs.(58.0±15.0)ml,t=-3.317,P=0.002]were significantly less than those in the open group.Conclusion Endoscopic Dunhill operation in the treatment of hyperthyroidism is a safe,effective and feasible method with good cosmetic results.