达芬奇机器人甲状腺切除术治疗单侧甲状腺微小乳头状癌效果观察

Efficacy observation of Da Vinci robotic thyroidectomy in treatment of the unilateral papillary thyroid microcarcinoma

目的探讨达芬奇机器人甲状腺切除术治疗单侧甲状腺微小乳头状癌(PTMC)的优势。方法回顾性分析山西医科大学第一医院2018年6月至2020年3月收治的49例单侧PTMC患者的临床资料, 根据手术方式分为达芬奇机器人组(试验组, 18例)及传统手术组(对照组, 31例)。分析比较两组患者的临床病理特征、术中和术后相关指标变化、住院时间、手术并发症发生率、手术费用;采用视觉模拟量表(VAS)评估患者术后疼痛情况。结果两组患者年龄、婚姻状况、受教育程度比较, 差异均有统计学意义(均P<0.05)。试验组与对照组中央区淋巴结清扫数[(4.3±2.0)个比(6.5±3.9)个]、手术时间[198.5 min(166.3 min, 228.5 min)比82.0 min(60.0 min, 102.0 min)]、术后24 h疼痛评分[3分(3分, 4分)比2分(2分, 3分)]、术后总引流量[49.0 ml(40.8 ml, 56.5 ml)比37.0 ml(29.0 ml, 44.0 ml)]、手术费用分别为[3.32万元(3.31万元, 3.40万元)比0.52万元(0.42万元, 0.59万元)]比较, 差异均有统计学意义(均P<0.05)。两组患者术后均无出血、脂肪液化、皮下瘀斑等并发症发生。结论与传统手术相比, 达芬奇机器人甲状腺切除术治疗单侧PTMC安全可靠, 具有良好的治疗效果。

Objective To investigate the advantages of Da Vinci robotic thyroidectomy in treatment of the unilateral papillary thyroid microcarcinoma(PTMC).Methods The clinical data of 49 patients with unilateral thyroid cancer admitted to the First Hospital of Shanxi Medical University from June 2018 to March 2020 were retrospectively analyzed,and they were divided into Da Vinci robotic group(the experimental group,18 cases)and conventional surgery group(the control group,31 cases)according to the surgical method.The clinicopathological characteristics,perioperative and postoperative related indexes changes,length of hospital stay,incidence of surgical complications,and operation cost of both groups of patients were analyzed.Visual analogue scale(VAS)was used to evaluate postoperative pain.Results There were statistically significant differences in age,marriage and education background of both groups(all P<0.05).There were statistically significant differences in the number of central lymph node dissection[(4.3±2.0)vs.(6.5±3.9)],operation time[198.5 min(166.3 min,228.5 min)vs.82.0 min(60.0 min,102.0 min)],pain score of 24 h after surgery[3 scores(3 scores,4 scores)vs.2 scores(2 scores,3 scores)],postoperative total drainage volume[49.0 ml(40.8 ml,56.5 ml)vs.37.0 ml,(29.0 ml,44.0 ml)],operation cost[33,200 yuan(33,100 yuan,34,000 yuan)vs.5,200 yuan(4,200 yuan,5,900 yuan)],and differences were statistically significant(all P<0.05).No postoperative complications such as hemorrhage,fat liquefaction and subcutaneous ecchymosis occurred in all patients of the two groups.Conclusion Da Vinci robotic thyroidectomy is safe and reliable in treatment of the unilateral PTMC,and it has good therapeutic effects.