机器人与开放手术治疗直径大于5 cm甲状腺良性肿瘤效果对比

Comparsion of the clinical application between Da Vinci robot and open operation in thyroid benign tumor with diameter greater than 5 cm

目的探讨达芬奇机器人在直径大于5 cm甲状腺良性肿瘤手术应用中的可行性及安全性。方法回顾性分析2014年1月-2019年6月在解放军第九六〇医院(原济南军区总医院)甲状腺乳腺外科接受达芬奇机器人甲状腺良性肿瘤手术的36例患者(机器人组)的临床资料,并与同期进行接受开放手术的48例患者(开放组)进行比较。观察两组的手术时间、术中出血量、住院时间、术后引流量、术后甲状旁腺素、美容效果、手术并发症发生率、术后复发率等。采用统计软件SPSS16.0对数据进行统计分析。结果两组患者均顺利完成手术,与开放组相比,机器人组手术时间(t=11.232,P<0.001)及术后引流量(t=2.892,P=0.003)多于开放组,美容效果更佳(t=3.291,P=0.024)。术中出血量(t=1.575,P=0.118)、住院时间(t=-1.784,P=0.091)、术后甲状旁腺素(t=1.892,P=0.086)、手术并发症发生率(χ2=3.291,P=0.610)、术后疼痛视觉模拟评分(t=-2.431,P=0.081)及术后复发率等差异无统计学意义(P>0.05)。随访前无复发病例。结论达芬奇机器人应用于有颈部无瘢痕需求的肿瘤直径5~8 cm的甲状腺良性肿瘤患者安全可行,且美容效果更佳。

Objective To evaluate the feasibility and safety of robotic thyroidectomy for treatment of thyroid benign tumor with diameter larger than 5cm.Methods The clinical data of 36 patients(in the robot group)who received Da Vinci robot thyroid benign tumor surgery in the thyroid breast Surgery Department of the 960th Hospital of the PLA(Former Jinan Military General Hospital of PLA)from Jan.2014 to Jun.2019 were retrospectively analyzed,and compared with 48 patients(in the open group)who received open surgery in the same period.The operative time,intraoperative blood loss,length of hospital stay,postoperative drainage volume,postoperative parathyroid hormone,cosmetic effect,incidence of surgical complications and postoperative recurrence rate of the two groups were observed.Statistical software SPSS16.0 was used for statistical analysis of the data.Results Both groups successfully completed the operation.Compared with the open group,the operation time(t=11.232,P<0.001)and postoperative drainage volume(t=2.892,P=0.003)of the robot group were more than those of the open group,and the aesthetic effect was better(t=3.291,P=0.024).Intraoperative blood loss(t=1.575,P=0.118),hospital stay(t=-1.784,P=0.091),postoperative PTH(t=1.892,P=0.086),incidence of surgical complications(χ2=3.291,P=0.610),visual analogue score of postoperative pain(t=-2.431,P=0.081)and postoperative recurrence rate were not significantly different(P>0.05).No recurrence occurred during follow-up.Conclusion For patients with a selective benign thyroid tumor with a diameter of 5-8 cm,the bilateral axillo-breast and transaxillary approach for thyroid surgery by Da Vinci robot are safe,effective and have better cosmetic results.