无充气经腋腔镜甲状腺手术对颈前区功能保护的临床研究

Clinical study on the protection of anterior cervical function in gasless transaxillary endoscopic thyroidectomy

目的:探讨无充气经腋腔镜甲状腺手术对颈前区功能的保护效果。方法:选取2020年9月至2022年3月收治的80例甲状腺手术患者,开放组(n=40)行常规甲状腺开放手术,经腋窝组(n=40)取腋窝前皱襞切口,建立隧道,行腔镜下甲状腺切除术。统计分析两组围术期指标、术后并发症、颈前区功能、切口愈合效果、颈部功能、嗓音、切口美容满意度等相关指标。结果:经腋窝组术中出血量少于开放组(P<0.05),取标本时间长于开放组(P<0.05),术后引流量多于开放组(P<0.05),两组手术时间差异无统计学意义(P>0.05)。术后第3天、6个月,经腋窝组欧洲五维健康量表评分、Hollander伤口评估量表评分均高于开放组(P<0.05),颈部损伤、颈部疼痛、吞咽障碍评分、嗓音障碍指数评分均低于开放组(P<0.05)。经腋窝组切口美容满意度高于开放组(P<0.05)。结论:无充气经腋腔镜甲状腺手术对颈前区功能保护的临床效果较常规开放手术好,可有效改善患者围术期指标,减少术后并发症的发生,提升颈前区功能、切口愈合效果、颈部功能、嗓音、切口美容满意度。

Objective:To study the clinical effect of gasless transaxillary endoscopic thyroidectomy on the protection of the function at anterior cervical region.Methods:A total of 80 patients undergoing thyroid surgery from Sep.2020 to Mar.2022 were selec-ted.The 40 patients in the open group underwent routine open thyroid surgery,and for the patients in the axillary group(n=40),the anterior axillary fold incision was made to establish a tunnel,and endoscopic thyroidectomy was performed.The perioperative indicators,postoperative complications,anterior cervical area function,incision healing effect,neck function,voice,and satisfaction of incision cosmetics of the 2 groups were statistically analyzed.Results:Compared with the open group,the transaxillary group had less intraoperative blood loss(P<0.05),longer specimen removal time(P<0.05),and more postoperative drainage volume(P<0.05),and there was no significant difference in operative time between the two groups(P>0.05).At third day and sixth month after operation,the European five dimensional health scale scores and Hollander scores of patients in the axillary group were higher than those in the open group(P<0.05),and the scores of neck injury,neck pain,dysphagia and voice disorder index were lower than those in the open group(P<0.05).The incision cosmetic satisfaction of the axillary group was higher than that of the open group(P<0.05).Conclusions:The clinical effect of gasless transaxillary endoscopic thyroidectomy on the protection of cervical anterior region function is better than c onventional open surgery.The gasless transaxillary endoscopic thyroidectomy can effectively improve perioperative indicators,reduce postoperative complications,and enhance patients'satisfaction with cervical anterior region function,incision healing effect,neck function,voice and incision aesthetics.