目的:评价裸眼3D腔镜甲状腺手术的安全性和疗效.方法:按制定的纳入和排除标准,纳入2015年4月至2016年12月间接受完全经口腔前庭3D腔镜甲状腺切除术的患者14名,其中偏光3D系统手术组患者8名,采用裸眼3D系统手术组患者6名,回顾比较两组患者的临床结局,以及手术医生的操作感受;患者随访1~6个月.结果:偏光3D腔镜手术组平均年龄(43.13±15.69)岁,BMI(24.49±3.42)kg/m2,裸眼3D系统手术组平均年龄(37.83±8.80)岁,BMI(20.97±2.36)kg/m2,两组比较无显著差异.偏光3D手术组的平均手术时间(218.30±46.30)min,术中失血量为(10.43±4.96)mL,术后平均住院天数为(4.50±0.54)d;裸眼3D手术组平均手术时间为(203.83±58.40)min,术中失血量为(12.12±5.99)mL,术后平均住院天数为(4.63±1.48)d;两组比较,均无统计学差异,两组患者均无围手术期并发症;术后6 h可进食凉全流,术后第1天即可恢复正常饮食;所有患者对手术效果和外观满意.裸眼3D系统能明显降低手术者的眼疲劳,手术医生主观评价使用裸眼3D系统的眼疲劳评分(3.67±0.52)明显低于使用偏光3D系统的眼疲劳评分(7.00±0.76)(P<0.05).腔镜下画面和非腔镜下操作的转换的视觉感受良好,符合2D操作的操作感受,画面的色彩饱和度和亮度优于偏光3D系统.但由于目前的裸眼3D系统仅能对术者实施裸眼,助手的感受没有得到相应的改善.结论:在完全经口腔前庭入路腔镜甲状腺手术中,裸眼3D显像腔镜手术系统的疗效与安全性与常规偏光3D显像腔镜系统相当,并能明显降低术者的眼疲劳,维持良好的画面色彩饱和度和亮度,并可潜在提高手术效率.%Aim:To evaluate the safety and efficacy of trans-oral glasses-free 3D endoscopic thyoidec-tomy.Methods:A retrospective analysis was carried out on patients undergone trans-oral thyroidectomy by means of three dimensional (3D)endoscopic system.Clinical outcomes such as operation duration, intraoperation blood loss and the perioperative complications were accessed and evaluated between the group of using polarized 3D system and the group of using glasses-free 3D system.From April 2015 to December 2016.based on the including criteria,there were 14 patients were included for analysis.8 of them were underwent polarized 3D endoscopic operations and the rests of 6 patients were underwent glas-ses-free 3D endoscopic operations.The eye fatigues of surgeons were evaluated by Visual analogue scale. Post-operation follow-up was from 1 to 6 months.Results:The mean age of the polarized 3D group was (43.13 ±15.69)years old,and the mean BMI was (24.49 ±3.42)kg/m2 .While the mean age of the glasses-free 3D group was (37.83 ±8.80)years old,and their mean BMI was (20.97 ±2.36)kg/m2 . There was no significant difference between the two groups.In the group of polarized 3D operation,the mean operation duration was (203.83 ±58.40)min,intraoperation blood loss (12.12 ±5.99)mL,post-operation hospitalization was (4.63 ±1.48)days.In the group of glasses-free 3D operation,the mean operation duration of was (218.30 ±46.30)min,intraoperation blood loss was (10.43 ±4.96)mL, post-operation hospitalization was (4.50 ±0.54)days.No significant difference between the two groups was detected statistically.No post-operation complications were found.Cool liquid diet was allowed 6 hours after surgery,and they returned to normal diet on the next day after surgery.All patients were sat-isfied with the cosmetic results.For the surgeons,glasses-free 3D system was consistent with the felling in 2D system but provided excellent quality of 3D pictures including brightness and saturation on the screen.Visual analogue scale for eye fatigues of surgeon in the group of using glasses-free 3D system was (3.67 ±0.52),significantly lower than that of (7.00 ±0.76)in the group of using polarized 3D system (P <0.05).However,eye fatigues of the assistants were the same in the two groups since they had to worn polarized 3D glasses in the two systems.Conclusion:Glasses-free 3D endoscopic system is as safe and of efficacy as polarized 3D endoscopic system in totally oral vestibule access endoscopic thyroidecto-my.Moreover,it can reduce eye fatigues of the surgeon greatly by providing excellent quality of 3D pic-tures on the screen and is consistent with the felling in 2D system in the procedure.
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