经胸乳入路3D腔镜甲状腺次全切除术在基层医院的应用

目的探讨运用3D腔镜系统进行经胸乳入路甲状腺次全切除术在基层医院的安全性、有效性及可行性。方法分析在2013年9月~2016年4月南方医科大学第五附属医院普通外科行甲状腺手术患者的临床资料,患者分别行开放手术、2D腔镜下手术、3D腔镜下手术,各组20例,以及同期在合作三甲医院(珠江医院)行相同手术患者的临床资料,各组30例,比较各组手术时间、术中出血量、术后引流量、术后住院时间、并发症、总住院费用、医院间数据差异。结果二级医院3D组手术时间为69.21±11.60 min,2D组为56.22±6.57 min,开放组为40.93±10.60 min,组间存在统计学差异(F=41.64,P0.05);在二级医院住院费用为9733±1410元),三级医院住院费用为11511±1749,医院间费用比较存在统计学差异(t=-3.41,P0.05);术中出血量、术后引流量及术后住院时间无明显差异(P0.05)。结论腔镜技术被运用于基层医院开展经乳晕甲状腺次全切除术是经济及可行的,可做为甲状腺次全切除术的常规手术方法,需根据年手术总量配备2D或3D系统。

Application of 3D endoscopic thyroidectomy via breast approach in primary hospital

Objective To evaluate the efficacy for subtotal thyroidectomy from transvesical approach in primary hospital. Methods The clinical data of thyroid surgery patients in the Fifth Affiliated Hospital of Southern Medical University from September ，2013 to April ，2016 were analyzed. The patients underwent open surgery（open group，n=20），2D endoscopic surgery（2D group，n=20）and 3D endoscopic surgery （3D group ，n=20），respectively. The clinical data of thyroid surgery patients in Zhujiang Hospital were analyzed in same period and 30 cases were in each group. The operative time， intraoperative blood loss，postoperative drainage volume，postoperative hospital stay，complications，total operative complications，hospital costs and hospital data differences were compared between the three groups. Results The time of operation was 69.21±11.6 min in 2D group，56.22±6.57 min in 2D group and 40.93±10.6 min in open group（F=41.64，P<0.05）. The hospitalization cost of secondary hospital was 9733±1410 yuan，the cost of tertiary hospital was 11511±1749，and the cost of hospital was statistically different（t=-3.41，P<0.05）. The intraoperative blood loss，the postoperative drainage volume and the postoperative hospitalization were not significantly different. Conclusion Endoscopic subtotal thyroidectomy via a breast approach is safe ，effective，economical and practical as conventional surgery in primary hospital. The selection of 2D or 3D systems was based on the amount of operation annually.