腔镜辅助小切口甲状腺手术与完全腔镜甲状腺切除术的对比分析

摘要

目的：对比分析腔镜辅助的小切口甲状腺切除术（ Miccoli ）和完全腔镜的甲状腺切除术（total endoscopic thyroidectomy ，TET）2种手术方式。方法统计分析了山东大学齐鲁医院和烟台毓璜顶医院自2012年1月至12月收治并选择行内镜甲状腺手术的患者共70例，其中行Miccoli术式46例，选择TET 24例（以下称为腔镜组），统计患者的性别、年龄、手术有关数据、术中及术后并发症、住院时间、患者主观感受、美容效果满意度等方面情况并做出分析，以对比2种手术方式在安全性、创伤性和美容效果上的差异。结果①安全性：2组均无永久性喉返神经和甲状旁腺损伤出现，小切口组1例中转开放而腔镜组手术无一中转（2.2％vs 0％，P＞0.05）。②创伤性：小切口组术中出血及术后引流量均明显少于腔镜组，P＜0.05；术后疼痛评分6 h时2组差异无统计学意义，而12和24 h小切口组疼痛评分要低于腔镜组， P＜0.05。术前1 d、术后1 d和术后3 d CRP水平2组间差异无统计学意义，P＞0.05。③美容满意度及其他：术后美容效果满意度评分2组差异无统计学意义。结论2种术式安全性类似，都有较好的临床效果；2种术式创伤性类似，均在可接受的范围内；2者美容效果患者满意度类似。%Objective To analyze the advantages and disadvantages of minimally invasive video -assisted thyroidectomy(MIVAT)and totally endoscopic thyroidectomy (TET).Methods The study included 70 patients undergoing MIVAT and TET at Qilu Hospital of Shandong University and Yantai Yuhuangding Hospital from Jan . 2012 to Dec.2012.46 patients undergoing MIVAT(MIVAT group)and 24 patients undergoing TET(TET group) were analyzed retrospectively .Data of gender,age,operative data,intraoperative and postoperative complications , length of stay , feelings of patients and cosmetic effect were collected and analyzed .MIVAT and TET were com-pared in terms of safety ,trauma and cosmetic effect .Results ①About safety:no permanent recurrent laryngeal nerve(RLN)palsy and parathyroid injury occurred in either group .One case in MIVAT group and no case in TET group was converted to open surgery (2.2%vs 0%,P>0.05) .②About trauma:the intraoperative blood loss and postoperative drainage amount in the MIVAT group were significantly less than those in the TET group ( P <0.05).Postoperative VAS score at 6 hours was similar,but MIVAT group showed lower postoperative VAS score than TET group at 12 hours and 24 hours ( P<0.05 ) .No significant difference was observed between the 2 groups about C reactive protein (CRP)on the 1st day before operation,the 1st and 3rd day after operation(P>0.05).③About cosmetic effect:the 2 groups had similar patient satisfaction index .Conclusions The study shows similar results in safety and trauma .The 2 approaches are both safe and valid .Patients using the two ap-proaches are equally satisfied with the cosmetic effect .