改良Miccoli腔镜辅助下手术和经乳晕入路单孔法内镜下治疗甲状腺良性肿瘤效果观察

Observation of the curative effect of modified Miccoli endoscope-assisted surgery and endoscopic surgery via transareola single-hole method on benign thyroid tumors

目的探讨改良Miccoli腔镜辅助下手术和经乳晕入路单孔法内镜下治疗甲状腺良性肿瘤的效果。方法对2015年8月~2017年3月我院60例甲状腺良性肿瘤患者进行筛选,依据患者意愿及要求选择手术治疗方式,对改良Miccoli组(30例)与经乳晕单孔组(30例)围术期机体创伤指标、手术指标、术后切口美容效果、术后疼痛指标等展开对比。结果两组创伤相关指标在术前均无差异(P>0.05),术后WBC、TSH测验水平均上升,血钙、PTH测验水平下降,且改良Miccoli组波动幅度相较经乳晕单孔组更为轻微,差异有统计学意义(P<0.05)。改良Miccoli组手术切口大小、术中出血量、术后引流总量、手术时间、住院时间指标统计均较经乳晕单孔组显著下降(P<0.05),住院费用远高于经乳晕单孔组(P<0.05)。改良Miccoli组患者颈部活动恢复时间相较经乳晕单孔组明显缩短,术后6 h、12 h及24 h疼痛值低于经乳晕单孔组(P<0.05)。对术后1周、1个月及1年切口的美容效果比较,改良Miccoli组均较经乳晕单孔组评分高(P<0.05)。改良Miccoli组并发症总发生率(10%)低于经乳晕单孔组(20%),差异有统计学意义(P<0.05);总满意度(93.33%)高于经乳晕单孔组(86.67%),但差异无统计学意义(P>0.05)。结论对甲状腺良性肿瘤患者予以改良Miccoli腔镜辅助手术及经乳晕入路单孔法内镜治疗,均可取得满意效果,但相对而言,前者对患者机体所造成的创伤应激更小,但费用更高,且后者手术切口位于隐秘部位,颈部无创,故临床在选择术式可充分考虑患者意愿,取更适宜术式。

Objective To probe into the curative effect of modified Miccoli endoscope-assisted surgery and endoscopic surgery via transareola single-hole method on benign thyroid tumors.Methods A total of 60 patients with benign thyroid tumors in our hospital from August 2015 to March 2017 were selected,and the surgical treatment methods were chosen according to their wishes and requirements.Between the modified Miccoli group(n=30)and the transareola single-hole method group(n=30),comparisons were made in perioperative body trauma index,surgical index,postoperative incision cosmetic effect and postoperative pain indexes,etc.Results There were no differences in trauma-related indexes between the two groups before operation(P>0.05).After operation,the test levels of WBC and TSH increased,while the test levels of blood calcium and PTH decreased,and the fluctuation range of the modified Miccoli group was slighter than that of the transareola single-hole method group,with statistically significant differences(P<0.05).The surgical incision size,intraoperative blood loss,total volume of postoperative drainage,operation duration and hospital stay of the modified Miccoli group were all significantly smaller than those of the transareola single-hole method group(P<0.05),whose hospitalization cost was much higher than that of the transareda single-hole method group(P<0.05).The recovery time of neck activity in the modified Miccoli group was significantly shorter than that in the transareola single-hole method group,and the pain values at 6 h,12 h and 24 h after operation were lower than those in the transareola single-hole method group(P<0.05).When postoperative incision cosmetic effect at 1 week,1 month and 1 year was compared between the two groups,the scores of the modified Miccoli group were all higher than those of the transareola single-hole method group(P<0.05).The total incidence rate of complications of the modified Miccoli group(10%)was lower than 20%of the transareola single-hole method group,the difference was statistically significant(P<0.05).and the total satisfaction degree(93.33%)was higher than 86.67%of the transareola single-hole method group,with no statistically significant difference(P>0.05).Conclusion Both modified Miccoli endoscope-assisted surgery and endoscopic surgery via transareola single-hole method can produce satisfactory curative effect on the patients with benign thyroid tumors.However,relatively speaking,the former incurs less traumatic stress on the patients'bodies with higher cost,and the surgical incision of the latter is located in a hidden place,with no neck invasion.Accordingly,the patients'wishes can be fully taken into account in clinical selection of surgical methods to adopt a more suitable surgical method.