单中心分化型甲状腺癌全乳晕径路内镜手术学习曲线分析

目的 评估单中心治疗分化型甲状腺癌全乳晕径路内镜手术的近期疗效,并进一步分析其学习曲线。方法 回顾性分析2015年11月至2017年5月上海交通大学医学院附属瑞金医院北院普外科开展的100例全乳晕径路内镜手术治疗分化型甲状腺癌病例。按手术先后顺序将所有病例分为5组,A、B、C、D及E组各20例。比较各组在手术数据（包括各阶段和总手术时间、术中出血量、淋巴结清扫数、甲状旁腺误切率、开放甲状腺手术中转率和术中并发症发生例数）及术后相关数据（包括术后住院时间、总引流量和术后并发症发生例数）的差异,绘制并分析学习曲线。结果 所有入组病例均完成全乳晕径路内镜手术,无中转。比较各组总手术时间及各阶段手术时间,差异有统计学意义（P<0.001）。A组共发生术中并发症3例,多于其余各组（P=0.035）。A组发生术后皮瓣淤斑12例,多于其余各组（P<0.001）。多因素学习曲线函数分析表明,学习期例数为31例。结论 分化型甲状腺癌全乳晕径路内镜手术具有较长的学习曲线学习期,针对其特点行有效规范的操作是手术安全可行的保障。

Learning curve of endoscopic thyroidectomy via areola approach at a single centre for differentiated thyroid carcinoma

Objective To investigate the short outcome and the learning curve of endoscopic thyroidectomy via areola approach at a single centre for differentiated thyroid carcinoma. Methods A retrospective analysis was made with 100 patients undergoing endoscopic thyroidectomy via areola approach in the treatment of differentiated thyroid carcinoma from November 2015 to May 2017. The consecutive cases were divided into 5 groups as group A, B, C, D and E each 20 cases. Surgical data including the time of procedure such as flap dissection, thyroid resection and lymphadectomy, total operating time, operative blood loss, lymph node harvest, injury to the parathyroid glands, conversion and intraoperative complications, and postoperative data including hospital stay, drainage volume and postoperative complications were compared among 5 groups. Learning curve was analyzed using mathematical model. Results All patients underwent endoscopic thyroidectomy via areola approach without conversions. There was statistical difference of total operating time and the time of procedures among groups (P<0.001). Group A had 3 cases with intraoperative complications more than other groups (P=0.035). Groups A had 12 cases with subcutaneous ecchymosis more than other groups (P<0.001). Analysis of multivariate learning curve showed that the learning phase included 31 patients. Conclusions It was shown that endoscopic thyroidectomy via areola approach for differentiated thyroid carcinoma has longer learning phase. Effective and standard manipulation in view of special characteristics would make endoscopic thyroidectomy via areola approach safe and feasible.