全腔镜技术在原发性甲状腺功能亢进外科治疗中的应用

Application of total endoscopic technique in the surgical treatment of primary hyperthyroidism

目的:探讨全腔镜手术治疗原发性甲状腺功能亢进的临床效果。方法:回顾分析2015年1月至2019年1月收治的76例原发性甲状腺功能亢进患者的临床资料,均行双侧甲状腺次全切除术,其中全腔镜组32例,开放手术组44例。对比分析两种术式的术中情况、近期并发症及远期并发症。结果:全腔镜组手术时间长于开放组(P<0.05),失血量则少于开放组(P<0.05);两组术后放置引流管时间、术后引流总量差异无统计学意义(P>0.05)。全腔镜组疼痛评分小于开放组(P<0.05),两组出血、甲亢危象、暂时性甲状旁腺功能减退、暂时性喉返神经麻痹、甲亢复发、甲状腺功能低下等发生率差异无统计学意义(P>0.05);两组均未发生永久性喉返神经损伤、永久性甲状旁腺机能减退;全腔镜组美容效果优于开放组(P<0.05)。结论:对于甲状腺Ⅰ、Ⅱ度肿大的原发性甲状腺功能亢进患者,经过严格的术前准备,全腔镜手术的有效性及安全性与开放手术相当,且微创及美容效果良好。

Objective:To evaluate the clinical effect of totally endoscopic thyroidectomy in the treatment of primary hyperthyroidism.Methods:Clinical data of 76 patients who underwent bilateral subtotal thyroidectomy for primary hyperthyroidism from Jan.2015 to Jan.2019 were retrospectively analyzed,including 32 patients treated by total endoscopic thyroidectomy(TET)and 44 patients by open thyroidectomy(OT).The intraoperative status,early complications,and long-term complications in two groups were compared and analyzed.Results:In the aspect of the intraoperative status comparison,the TET group had superior results in the intraoperative blood loss than the OT group,with statistically significant difference,however,the operating time was longer in the TET group than the OT group(P<0.05).There was no statistically significant difference in the postoperative drainage time and the amount of postoperative drainage(P>0.05).In the aspect of the early complications comparison,the TET had lower postoperative pain score than the OT group with statistically significant difference(P<0.05).There was not statistically significant difference in the amount of postoperative bleeding,hyperthyroidism crisis,transient hypoparathyroidism,transient recurrent laryngeal nerve paralysis(P>0.05).In the aspect of the late complication comparison,the TET group had greater cosmetic satisfaction than the OT group with statistically significant difference(P<0.05).The permanent recurrent laryngeal nerve paralysis and permanent hypoparathyroidism did not happen in the patients in the two groups.There was no statistically significant difference in the hyperthyroidism recurrence or hypothyroidism(P>0.05).Conclusions:Endoscopic procedure has the same effectiveness and safety with open procedure for primary hyperthyroidism patients with thyroid enlargement of degreeⅠandⅡafter critical preoperative preparation,and has better cosmetic and minimally invasive effects than open procedure.