可视穿刺器联合加长Trocar建腔在全乳晕入路腔镜甲状腺手术中的应用

Clinical application of cavity construction with visual puncture and extended Trocar in endoscopic thyroid surgery through the total areola approach

目的探讨可视穿刺器联合加长Trocar建腔在全乳晕入路腔镜甲状腺手术中的临床应用价值。方法回顾性队列研究。纳入蚌埠医学院第一附属医院肿瘤外科2019年1月—2021年12月收治的70例全乳晕入路腔镜甲状腺手术患者的临床资料。其中男4例、女66例,年龄22~58岁。采用可视穿刺器建腔四步法联合加长Trocar建腔技术35例为观察组;采用分离棒钝性分离法建腔技术35例为对照组。比较2组患者全乳晕入路建腔完成时间、皮下分离面积及不良事件(Trocar通道出血,以及术后皮肤感觉异常、皮脂腺囊肿形成、脂肪液化、局部淤血瘀斑等皮肤并发症)的发生率。结果患者均顺利完成建腔,术后均获随访3个月。2组患者的性别、年龄、体质量指数、甲状腺全切术、单侧甲状腺切除术等一般资料差异均无统计学意义(P值均>0.05)。观察组建腔完成时间为(10.5±2.2)min,短于对照组的(30.5±4.2)min,差异有统计学意义(t=24.67,P<0.001);观察组皮下分离面积(65.05±5.04)cm2,明显小于对照组的(80.06±8.08)cm^(2),差异有统计学意义(t=-9.32,P<0.001)。观察组患者发生Trocar通道出血1例(2.86%,1/35);对照组患者发生不良事件11例(31.43%,11/35),差异有统计学意义(χ^(2)=10.06,P=0.002)。结论可视穿刺器联合加长Trocar应用于全乳晕入路腔镜甲状腺手术中,可以帮助术者简单、快速、安全、有效地建腔,有较高的临床应用价值。

This study aims to investigate the clinical application of cavity construction with visual puncture and extended Trocar in endoscopic thyroid surgery through the total areola approach.Methods This is a retrospective cohort study.The clinical data of 70 patients who underwent endoscopic thyroid surgery through the whole areola approach admitted to the Department of Surgical Oncology,the First Affiliated Hospital of Bengbu Medical College from January 2019 to December 2021 were included.The patients included 4 males and 66 females,their ages ranged from 22 years to 58 years.A total of 35 cases were placed into the observation group by the 4-step technique of cavity construction with visual puncture and extended Trocar device,and 35 cases were placed into the control group by the blunt separation technique.The completion time,subcutaneous separation area,and incidence of adverse events(e.g.,Trocar channel bleeding,postoperative skin paresthesia,sebaceous cyst formation,fat liquefaction,local ecchymosis,and other skin complications)of the two groups were compared.Results Cavity construction was successfully completed in both groups.All patients were followed up for three months.No significant difference in gender,age,body mass index,total thyroidectomy,unilateral thyroidectomy,and other general data was observed between the two groups(all P values>0.05).The completion time of cavity construction of the observation group was(10.5±2.2)min,which was significantly shorter than that of the control group([30.5±4.2]min;t=24.67,P<0.001).The subcutaneous separation area of the observation group was(65.05±5.04)cm2,which was significantly smaller than that of the control group([80.06±8.08]cm^(2);t=-9.32,P<0.001).In the study group,a patient(2.86%,1/35)had Trocar catheter bleeding.Adverse events occurred in 11 patients(31.43%,11/35)in the control group,and the difference was statistically significant(χ^(2)=10.06,P=0.002).Conclusion The method of visual puncture and extended Trocar can help the surgeon to construct cavity simply,quickly,safely,and effectively in endoscopic thyroid surgery through the total areola approach.This method has high clinical application value.