无充气腋窝入路腔镜下双侧甲状腺手术初步体会

Preliminary experience of endoscopic bilateral thyroid surgery through gasless axillary approach

目的探讨无充气腋窝入路腔镜甲状腺手术(endoscopic thyroidectomy by gasless unilateral axillary approach,ETGUA)应用于双侧甲状腺手术的有效性和安全性。方法回顾性匹配研究分析2019年3月至2021年9月浙江省人民医院头颈外科收治的21例进行ETGUA的患者,其中8例为双侧甲状腺癌根治术,13例为单侧甲状腺癌根治术+对侧腺叶切除术(良性)。同时匹配23例行传统颈部切口开放甲状腺手术(conventional open thyroidectomy,COT)的患者作为对照组,其中8例行双侧甲状腺癌根治术,15例单侧甲状腺癌根治术+对侧腺叶切除术(良性),记录ETGUA手术过程,并比较腔镜组与开放组在手术安全性、创伤、术后恢复、患者满意度的差异。以IBM SPSS 25.0软件进行统计分析,Students t测试和χ^(2)检验分析被用来各自分析持续和分类数据。结果手术时长腔镜组(148.67±57.44)min大于开放组(88.48±42.17)min,术后引流量腔镜组大于开放组[(186.52±83.24)ml vs(128.91±116.04)ml,P=0.010],术中出血量[(41.11±43.20)ml vs(29.44±24.55)ml,P=0.796]、术后住院时间[(4.90±0.94)d vs(4.86±1.06)d,P=0.774]、并发症发生率方面差异无统计学意义。腔镜组在术后1 d、1个月及3个月颈部疼痛评分都优于开放组[(2.33±0.91)vs(3.48±1.12),(1.24±0.44)vs(1.70±0.76),(1 vs 1.17±0.39),P=0.001,P<0.032,P<0.048]。在术后美容满意度上,腔镜组优于开放组(1 vs 2.09±0.67,P<0.001)。结论ETGUA是一种安全有效,且美容满意度高的手术方式。

Objective To investigate the feasibility and safety of endoscopic thyroidectomy by gasless unilateral axillary approach.Methods A matching study was conducted to analyze 21 patients with etgua of Zhejiang Provincial People’s Hospital from Mar.2019 to Sep.2021,including 8 cases of bilateral radical thyroidectomy and 13 cases of unilateral radical thyroidectomy+contralateral lobectomy(benign).At the same time,23 patients who underwent conventional thyroidectomy were matched as controls,including 8 cases of bilateral radical thyroidectomy and 15 cases of unilateral radical thyroidectomy+contralateral lobectomy(benign).The operation process was recorded,and the differences in operation safety,postoperative recovery and incision satisfaction between endoscopic group and open group were compared.Results The operation time in the endoscopy group was longer than that in the open group.The postoperative drainage volume in the endoscopy group was larger than that in the open group.There was no significant difference in the amount of intraoperative bleeding,postoperative stay in hospital or the incidence of complications.The neck pain scores in the endoscopic group were lowter than those in the open group.In terms of postoperative cosmetic satisfaction,the endoscopic group was higher than the open group.Conclusion Endoscopic bilateral thyroidectomy by gasless unilateral axillary approach is a safe and effective surgical method,and has high cosmetic satisfaction.