经胸前入路无注气腔镜手术在早期甲状腺乳头犬癌的应用研究+

摘要

Objective To explore the effectiveness of endoscopic thyroidectomy for early papillary thyroid carcinoma (T,N0M0) via a gasless anterior chest approach. Methods From July 2007 to October 2010, 30 cases received endoscopic thyroidectomy ( endoscopic group). At the same time, 30 cases who underwent conventional thyroidectomy were enrolled as a control group (conventional group). Operation time, intraoperative blood loss, postoperative drainage,complication rate, and the number of removed central lymph nodes were evaluated and analyzed. Results The mean operation time was ( 105. 4 ± 16. 3) min in endoscopic group and (101.6 ±21.0) min in conventional group,and the diffence was not significant (t =0.783 P = 0.437). There were no statistical differences in intraoperative blood [ ( 23. 5 ± 6. 2 ) ml vs. (20. 8 ± 15. 8 ) ml, t = 0. 871, P = 0. 387 ] , and postoperative drainage [ ( 22. 9 ± 7. 9 ) ml vs. ( 26. 6 ± 8. 4 ) ml, t = 1. 758, P = 0. 084 ] between the two groups. The number of removed central lymph nodes was 5. 2 ± 2. 3 in endoscopic group, and 6.3 ±2.4 in the conventional group (t = 1. 813 , P = 0. 075 ). Temporary postoperative hoarseness occurred in 5 cases totally ( 3 in endoscopic group and 2 in conventional group) , and temporary hypocalcemia was found in 2 cases (1 in endoscopic group and 1 in conventional group). The complication rate was not significantly different between these two groups (x2 =0. 144, P =0. 704) Conculsions Endoscopic thyroidectomy for early papillary thyroid carcinoma (T, No Mo) via a gasless anterior chest approach is effective and safe.%目的 探讨经胸前入路无注气腔镜下甲状腺手术治疗早期甲状腺乳头状癌(T1N0 M0)的疗效. 方法 2007年7月～2010年10月,选择30例接受腔镜手术(腔镜组)和30例传统开放手术(开放组),比较2组手术时间、术中出血量、术后引流量、术后并发症发生率、清除中央组淋巴数量等. 结果 腔镜组手术时间(105.4±16.3) min与开放组(101.6±21.0)min无统计学差异(t=0.783,P=0.437);腔镜组手术出血量(23.5±6.2) ml与开放组(20.8±15.8)ml无统计学差异(t=0.871,P=0.387);腔镜组术后引流量(22.9±7.9)ml与开放组(26.6±8.4) ml无统计学差异(t=1.758,P=0.084);腔镜组28例清扫中央组淋巴(5.2±2.3)枚与开放组30例(6.3±2.4)枚无统计学差异(t=1.813,P=0.075).术后暂时性声嘶5例(腔镜组3例,开放组2例),暂时性手足麻木2组各1例,2组并发症发生率无统计学差异(x2=0.144,P=0.704).结论 胸前入路无注气腔镜下治疗T1N0M0甲状腺乳头状癌可行、安全有效.