经胸乳入路腔镜甲状腺手术与传统甲状腺手术的疗效对比

摘要

目的：对比经胸乳入路腔镜甲状腺手术与传统甲状腺手术的临床疗效，探讨经胸乳入路腔镜甲状腺手术的可行性和优势。方法：回顾性分析了2011年12月至2014年3月收治的314例接受手术治疗的甲状腺良性肿瘤患者的临床资料，其中腔镜组78例，行经胸乳入路腔镜甲状腺手术；开放组236例，行传统开放性甲状腺手术。采用统计学方法对两组手术时间、术中出血量、术后第一天引流量、使用止痛药物情况、术后并发症、术后住院时间情况进行对比分析，并进行术后随访。结果：腔镜组手术时间为（82．0±23．5）min，长于开放组（57．7±13．7）min，差异有统计学意义（P ＜0．01）；腔镜组术中出血量（13．9±7．6）ml 低于开放组（33．9±15．4）ml，差异有统计学意义（P ＜0．01）；术后第一天出血量（22．3±8．7）ml 少于开放组（36．0±17．8）ml，差异有统计学意义（P ＜0．01）；术后住院时间分别为（2．4±0．9）天和（3．6±1．2）天，差异有统计学意义（P ＜0．01）；腔镜组患者术后使用止痛药的比例小于开放组；腔镜组术后无严重并发症，并发症发生率与开放组无差异且均较低，术后随访半年，未出现甲状腺功能减退和复发。结论：经胸乳入路腔镜甲状腺手术是一种安全、可靠的手术方式，具有出血少、住院时间短、疼痛轻和颈部无疤痕等优势。%Objective:To compare the clinical efficiency of endoscopic thyroidectomy by trans -thoracoareolar ap-proach with conventional open thyroidectomy,to explore the feasibility and advantage of endoscopic thyroidectomy. Methods:The clinical data of 314 cases of benign thyroid tumor patients who treated with surgery from December 2011 to March 2014 were analyzed retrospectively(endoscopy group:78 cases of endoscopic thyroidectomy by trans -thoracoareolar approach,open group:236 cases of conventional open thyroidectomy,).Operative time,blood loss,the volume of drainage in the first day after operation,use of painkillers,postoperative complications,time of postoperative stay and postoperative follow -up studies were compared.Results:The operation time in group endoscopy was(82.0 ±23.5)min,longer than open group(57.7 ±13.7)min,the difference was statistically significant(P <0.05).The blood loss of endoscopy group was (13.9 ±7.6)ml,much less than the open group(33.9 ±15.4)ml,the difference was statistically significant(P <0.01).The volume of drainage in the first day after operation of group endoscopy was (22.3 ±8.7)ml,less than open group(36.0 ±17.8)ml,the difference was significant(P <0.01).The postoperative stay of endoscopy group was(2 .4 ±0 .9 )d,less than open group(3.6 ±1.2)d,the difference was significant(P<0.01).The use of painkillers in endoscopy group was less than open group.The postoperative complications,time of postoperative stay and postoperative follow -up studies were both low in the two groups,and the differences were not statistically significant.Conclusion:Endoscopic thyroidectomy by trans -thoracoareolar approach is a safe and feasi-ble method.The advantages of endoscopic thyroidectomy by trans -thoracoareolar approach were less blood loss,less time of postoperative stay,less pain and no scar on the neck.