经胸乳入路腔镜下甲状腺切除术临床研究

摘要

Objective To evaluate the effects of endoscopic thyroidectomy by breast approach. Methods 60 cases of patients with thyroid neoplasm were randomly divided into two groups, the observation group of 30 patients were treated with endoscopic thyroidectomy by breast approach; the control group of 30 patients were treated with conventional open thy -roidectomy; Operative time, blood loss, time taken to normal activity and postoperative stay, postoperative complications and analgesic requirements, time taken to return to normal activity and total fee were compared between the two groups. Results There was no significantly difference in operative time, time of stay and post-operation stay between the two groups (P > 0.05). Blood loss was significantly less in observation group [(43.6 ±21.2) d] than in control group [(120.3 ± 58.8) d] (P = 0), but the volume of drainage in control group [(85.1±41.3)mL] were more than in observation group[(45.3± 20.5)mL] (P = 0); there was not statistically significant difference of time return to normal activity between the two groups (P > 0.05). The analgesic requirements were less in observation group (16.1%) than that in control group (39.7%) (P = 0.045); but it costs more than control group [(8 015.5±3 535.6) yuan vs (6 030.2±l 232.3) yuan](P =0.005). The significant postoperative complication in observation group was laryngeal nerve and recurrent laryngeal nerve injury, and hemorrhage was the significant postoperative complication in control group. Conclusion Compared with conventional surgery, endoscopic thyroidectomy for thyroid disease is a feasible, practical and safe procedure, with excellent cosmetic benefits, less blood loss and pain.%目的 探讨经胸乳入路腔镜下甲状腺切除术的可行性及疗效.方法 60例诊断为甲状腺肿物的患者,按随机数字表分为观察组和对照组,观察组30例,采用经胸乳入路腔镜下甲状腺切除术治疗,对照组30例,采用传统开放甲状腺切除术治疗,比较两组的手术时间、出血量、引流量、住院时间、术后住院时间、术后恢复活动时间、术后镇痛药的需求、住院费用等.结果 两组的手术时间、住院时间、术后住院时间比较差异无统计学意义(P > 0.05);观察组的出血量[(43.6±21.2)mL]明显少于对照组[(120.3±58.8)mL],差异有统计学意义(P = 0);而对照组引流量比[(85.1±41.3)mL]观察组[(45.3±20.5)mL]多(P = 0);观察组术后恢复活动时间与对照组比较差异无统计学意义(P > 0.05);观察组术后镇痛药需求(16.1%)比对照组(39.7%)明显减少(P = 0.045),而住院费用观察组[(8 015.5±3 535.6)元]高于对照组[(6 030.2±1 232.3)元](P = 0.005);观察组术后并发症以喉上和喉返神经损伤为主,而对照组主要是出血.结论 经胸乳入路腔镜甲状腺手术是一种安全、可行的方法,具有美容、疼痛轻和出血少的优点.