腔镜辅助下与全腔镜甲状腺手术的临床对比研究

目的对比研究腔镜辅助下与全腔镜下甲状腺手术治疗良性甲状腺瘤的安全性及复发率。方法按照自愿原则将185例接受甲状腺手术的患者分为2组,研究组100例,采取腔镜辅助手术。对照组85例,采用全腔镜手术。对比2组手术时间、术中出血量、术后疼痛VAS评分、并发症发生率、住院时间及随访1 a复发率。结果 2组患者均成功完成手术,无中转者。2组手术时间及随访1 a复发率无显著性差异,但研究组住院时间更短,术中出血量更少,术后疼痛评分、并发症发生率更低,组间比较差异有统计学意义(P0.05)。结论良性甲状腺肿瘤患者应用腹腔镜辅助或全腔镜甲状腺手术治疗效果一致,但腔镜辅助下手术安全性更高,患者疼痛更轻,值得借鉴。     

腔镜辅助与传统开放甲状腺切除术的对比研究

目的 探讨腔镜辅助甲状腺手术的安全性、微创性及美容效果.方法 比较我院行腔镜辅助下甲状腺手术230例,传统开放甲状腺手术204例的两种术式手术时间、术后住院时间、切口美容评分、甲状旁腺损伤、神经损伤、切口感染率和复发率.结果 腔镜组平均手术时间(33±29)min、术后平均住院时间(2±1)d,与开放组相比明显缩短(P值分别为0.025、0.000);术中甲状旁腺损伤(1.30%)、一过性神经损伤(1.74%),与开放组相比均明显降低(P值分别为0.021、0.009);术后美容满意度高(P=0.000);切口感染发生率无明显差别(P=0.270).随访6～30个月,两组复发率无差别(P=0.909).结论 腔镜辅助下甲状腺切除术有极佳的美容效果,手术时间短,术后住院时间短,特别是在降低甲状旁腺损伤,一过性神经损伤方面,具有明显的优势,是一种安全、有效的微创手术.     

腔镜辅助下与全腔镜甲状腺切除术的对比分析

目的:对比腔镜辅助下(video-assisted thyroidectomy,VAT)与全腔镜甲状腺切除术(total en-doscopic thyroidectomy,TET)的手术特点.方法:回顾性分析行胸骨切迹上径路颈部小切口VAT 65例和胸前壁径路TET 59例的临床资料.比较2种术式的手术时间、术中失血量、疼痛评分、术后住院时间、并发症和复发率.结果:120例手术成功,4例(VAT和TET组各2例)中转开放手术.VAT组和TET组手术时间分别为(44.15±12.11)min和(115.42±28.36)min,术中失血量分别为(9.54±4.21)mL和(20.68±7.40)mL,疼痛评分分别为3.62±0.93和5.37±0.90,术后住院时间分别为(3.31±0.86)d和(5.31±0.79)d,术后并发症发生率分别为1.54%和15.25%,2组差异均具有统计学意义(P<0.01或P<0.05).2组术后均无继发出血、永久性声嘶、低血钙等并发症.随访3～37个月,平均17.17个月,复发3例,其中VAT组1例,TET组2例,两组复发率差异无统计学意义(P>0.05).结论:2种腔镜手术治疗甲状腺良性肿瘤均安全有效.与TET相比,VAT技术难度较低,并发症较少,并具有创伤小、恢复快、术后疼痛轻等优点,是可选择的手术方式之一.     

腔镜甲状腺切除术九例体会

我院自2005年2月至2006年2月进行腔镜下甲状腺手术9例,取得了良好效果,现报告如下。临床资料1.一般资料:本组男3例,女6例,年龄31~50岁,平均37岁。其中结节性甲状腺肿7例,腺瘤1例,囊性变1例。单侧6例,双侧3例。2.手术方式:本组患者于术前均行甲状腺B超及CT检查,以便了解甲状腺结节的位置及层次,并进行甲状腺功能检测。全麻,取平卧位。于两乳连线胸骨前方作为进镜口,以肾上腺素盐水于胸颈前术野区域皮下浸润,由进镜口切开约1cm达深筋膜层,以长组织剪分离术野皮下组织。注入CO2气体并维持8mm Hg。另分别于两乳晕上方5cm开口,分别经Trocar摆…     

腔镜甲状腺切除术

甲状腺疾病多发于青年女性。传统的甲状腺切除术在颈部留下 6cm～ 8cm手术疤痕 ,给患者造成心理压力。因此 ,如何缩小手术切口和把切口转移到更隐蔽的部位 ,一直是甲状腺外科学者思索的问题。随着腹腔镜外科技术广泛而深入的发展 ,不少学者开始探索如何把腔镜外科技术运用于甲状腺手术中。甲状腺血管丰富 ,每叶有两条动脉和三条静脉 ,解剖结构精细复杂 ,与喉返神经、喉上神经、甲状旁腺和气管密切联系 ,而且不像胸腹腔脏器有天然的腔隙作为手术空间。所以 ,要进行腔镜甲状腺手术 ,必须考虑两点[1 ] :一是如何建立一个舒适的手术空间 ,最大限…     

腔镜辅助甲状腺切除术112例治疗体会

目的 探讨腔镜辅助甲状腺切除手术在甲状腺良性疾病治疗中的作用.方法 回顾性分析2004年1月至2008年6月采用腔镜辅助甲状腺切除术112例病例,总结手术经验和观察术后恢复情况.结果 112例手术均在腔镜辅助下完成,无中转手术.手术时间19～69min,平均43min,均未出现喉返神经短暂性及永久性损伤及甲状旁腺短暂性及永久性功能低下等并发症,术后2～4d出院,美容效果满意.结论 腔镜辅助甲状腺切除术安全可靠,并发症少,美容效果好.     

腔镜与传统开放甲状腺切除术的比较

目的探讨腔镜甲状腺切除术的优缺点。方法2003年12月~2004年8月,我院将甲状腺疾病61例随意分成2组,腔镜组30例,开放组31例。分析比较腔镜组与开放组的手术时间、术中出血量,住院时间,术后疼痛评分,术后3个月颈部感觉情况、吞咽情况及美容效果评价。结果开放组手术时间比腔镜组明显缩短[(78±34)m in vs.(126±53)m in,t=4.125,P=0.000)]。腔镜组术中出血量(20±13)m l,明显少于开放组(34±19)m l(t=-3.313,P=0.002)。术后24、48 h疼痛腔镜组比开放组轻(t=-3.255,P=0.002;t=-2.598,P==0.012)。术后3个月腔镜组1例发生颈部感觉减退,2例吞咽不适,开放组有11例颈部感觉减退或异常(2χ=10.894,P=0.001),9例吞咽不适(2χ=5.773,P=0.016)。腔镜组所有患者对术后美容效果均满意,开放组19例对术后美容效果不满意(2χ=52.141,P=0.000)。结论腔镜甲状腺切除术术中出血少、术后疼痛轻,有极佳的美容效果,是一种安全、有效的手术方法。     

完全腔镜及腔镜辅助小切口甲状旁腺腺瘤切除术临床对比分析

甲状旁腺腺瘤引起的甲状旁腺素异常增高可以通过手术切除腺瘤来治愈。手术方式可分为传统开放手术,完全腔镜下手术和腔镜辅助下小切口手术。完全腔镜下手术美容效果良好,但是否微创还有待商榷,腔镜辅助下小切口手术（Miccoli）美容效果及手术创伤居于传统手术和完全腔镜手术之间,但较容易掌握。     

颈前入路充气法单孔腔镜辅助甲状腺手术与传统开放手术的对比研究

目的 探讨颈前入路充气法单孔腔镜辅助甲状腺手术(黄氏手术)的安全性、可行性和优势。方法 回顾性分析2021年4月～2022年9月74例甲状腺良性结节行单侧甲状腺腺叶切除术的资料,其中42例行颈前入路充气法单孔腔镜辅助手术(腔镜组),32例行传统开放手术(开放组)。比较2组手术指标、术后并发症、患者对切口满意度等的差异。结果 腔镜组术后24小时疼痛评分小于开放组[(2.8±1.1)分vs.(3.7±1.0)分,t=-3.558,P=0.001],术后2个月患者对切口满意度高于开放组[85.7%(36/42)vs.59.4%(19/32),χ²=6.603,P=0.010],但住院费用高于开放组[(13.9±0.7)千元vs.(12.2±0.8)千元,t=10.135,P=0.000]。2组手术时间、术中出血量、术后引流量、术后住院时间及术后并发症发生率无显著差异(P>0.05)。结论 颈前入路充气法单孔腔镜辅助甲状腺手术安全可行,与开放手术相比具有切口小、疼痛轻、患者对切口满意度高等优点。     

内镜辅助和胸壁入路内镜甲状腺切除术与传统甲状腺切除术的比较

目的比较内镜辅助及胸壁入路内镜甲状腺切除术与传统甲状腺切除术创伤程度、术后疼痛、美容效果及2种内镜术式的各自特点。方法45例甲状腺结节按入院顺序分成3组,每组15例,分别行内镜辅助甲状腺切除术(endoscopicassisted thyroidectomy,EAT)、胸壁入路内镜甲状腺切除术(transthoracic endoscopic thyroidectomy,TET)及传统甲状腺切除术(conventional thyroidectomy,CT)。检测术前及术后24、72h血清CRP、IL-6、TNF-α、T淋巴细胞亚群(CD3,CD4+,CD8+,CD4+/CD8+)水平,评估手术创伤程度,视觉模拟评分法评估术后疼痛感受,5级评价法评估术后美容满意度。结果VAS疼痛评分:术后第1、3天EAT组分别为2.2±1.7、1.1±1.1,明显轻于TET组3.6±1.4、2.2±0.7(第1天q=3.698,P<0.05;第3天q=4.824,P<0.05)和CT组4.6±1.0、3.0±0.8(第1天q=6.339,P<0.05;第3天q=8.332,P<0.05)。美容满意度调查EAT、TET、CT组...     

Endoscopic Total Thyroidectomy

Background and Objective:

Endoscopic neck surgery for the thyroid and parathyroid is being tested as an alternative to open thyroidectomy. The aim of this study was to determine the safety and feasibility of endoscopic transaxillary total thyroidectomy (ETTT).

Methods and Results:

Twenty-two consecutive patients from January 2006 to September 2008 underwent ETTT. No conversions to open were necessary. Mean age was 49.3±12.9 years, 20 were female, and 2 were male. Mean operating time was 238 minutes±72.7. Mean blood loss was 40mL±28.3mL. Mean weight of the gland was 137.05g±129.21g. The recurrent laryngeal nerve was identified with no permanent injury. Six patients developed hoarseness of the voice for a mean of 15.1±8.01 days. No patient developed tetany or hypocalcemia requiring treatment. Six patients experienced transient numbness in the anterior chest wall lasting 2 weeks in 5 patients and 2 months in one. All patients were discharged within 24 hours of admission.

Conclusion:

ETTT requires additional operative time compared with the open approach, but is cosmetically favorable. Visualization of the nerve and parathyroid is much better. Although the learning curve is steep, with experience the operative time will decrease. ETTT is different but safe and feasible.     

胸乳入路腔镜与开放手术治疗甲状腺良性肿瘤的对比研究

目的 对比腔镜手术和开放甲状腺手术治疗甲状腺良性疾病的临床效果.方法 回顾性分析2008年1月～2010年6月54例腔镜和60例开放甲状腺切除术的临床资料.比较2组的手术时间、出血量、术后恢复活动时间、术后并发症和住院费用;采用疼痛视觉模拟评分（VAS评分）比较术后4、12、24和48小时疼痛情况;应用数字评分系统（numericalscore system,NSS）比较2组术后3和6个月对切口瘢痕的满意度.结果 2组手术时间差异无显著性[腔镜组（124.7±35.3） min,开放组（117.9±39.2）min,t＝0.979,P=0.330].腔镜组出血量少[（23.5±11.3）ml vs.（101.0±46.8） ml,t=-12.423,P=0.000],术后恢复活动时间短[（3.1±0.8）d vs.（5.7±1.5）d,t=-3.511,P=0.037];但住院费用高[（10 726.3±413.5）元vs.（7241.2±587.4）元,t=-2.327,P=0.045].腔镜组出现2例声音嘶哑、l例皮下瘀斑,开放组出现1例声音嘶哑、1例甲状腺功能减退,2组并发症发生率差异无显著性（Х^2=0.015,P=0.904）.腔镜组术后4、12、24小时VAS评分分别为（2.16±0.61）、（2.97±0.78）和（1.39±0.43）分,均显著低于开放组的（3.95±0.62）、（5.74±0.90）、（2.55±0.78）分（t=-9.486、-17.565、-9.994,P均＜0.05）;而2组术后48小时VAS评分差异无显著性.术后3和6个月腔镜组的NSS评分分别为（8.74±1.25）、（3.15±1.41）分,均显著高于开放组的（5.68±1.06）、（1.25±1.36）分（t=4.882,P=0.025;t=3.463,P=0.036）.结论 腔镜甲状腺手术具有切口美观、出血少、术后疼痛轻的优点,在治疗甲状腺良性疾病方面具有良好的发展前景.     

腔镜甲状腺手术与开放手术临床对比研究

目的比较腔镜手术和开放手术治疗甲状腺良性疾病的临床效果。方法回顾性分析2009年1月～2010年3月32例行腔镜甲状腺切除术和35例行开放甲状腺切除术患者的临床资料,比较两组手术时间、出血量、术后恢复活动时间、术后并发症、住院费用、患者对手术满意度等。结果腔镜组32例中除1例中转开放手术外,其余31例均获成功。两组手术时间比较无统计学差异(P>0.05);与开放组比较,腔镜组出血少,术后恢复时间短,费用高,患者对手术满意度高(P<0.05)。腔镜组术后有2例患者出现声音嘶哑等神经损伤症状,其中1例为桥本氏甲状腺炎患者,在术后4个月恢复,另1例为结节性甲状腺肿患者,术后1个月恢复正常。1例患者出现皮肤瘀斑,2周后恢复正常。开放组有2例并发症,其中喉返神经损伤1例,术后2个月自行恢复正常,甲状腺功能减退1例,口服甲状腺素片治疗。两组并发症率比较无统计学差异(P>0.05)。结论腔镜甲状腺手术具有美容效果好、出血少、术后恢复快的优点,在治疗甲状腺良性疾病方面,是具有良好发展前景的手术方式。     

Endoscopic Thyroidectomy for Thyroid Malignancies: Comparison with Conventional Open Thyroidectomy

Background Endoscopic techniques have recently been applied to thyroid surgery. We developed the bilateral axillo-breast (BAB) approach for total thyroidectomy. The aims of this study were to evaluate the completeness of this approach for total thyroidectomy and to compare complications between endoscopic thyroidectomy and conventional open thyroidectomy. Methods We analyzed 198 patients who underwent open thyroidectomy and 103 patients who underwent endoscopic thyroidectomy for papillary thyroid microcarcinoma between January 2003 and June 2006 at Seoul National University Hospital. The postoperative thyroglobulin (TG) level was used to assess the completeness of the two methods. Complications such as hypocalcemia or vocal cord palsy were also evaluated. Results The mean hospitalization period was 3.18 days following open thyroidectomy and 3.04 days after endoscopic thyroidectomy. The 3-month postoperative TG levels were <1.0 ng/ml in 90.4% of patients after open total thyroidectomy and in 88.9% following endoscopic total thyroidectomy. Transient hypocalcemia occurred in 17.7% and 25.2% of patients, respectively. Permanent hypocalcemia occurred in 4.5% and 1.0% of patients, respectively. Permanent vocal cord palsy frequencies were 0.5% and 0%, respectively. There were no significant differences in postoperative TG levels, hypocalcemia, or permanent vocal cord palsy. Transient vocal cord palsy occurred in 2.5% of patients after open thyroidectomy and in 25.2% after endoscopic thyroidectomy (p < 0.0001), but it disappeared within 3 months. Cosmetic results were excellent after endoscopic thyroidectomy. Conclusions The bilateral axillo-breast (BAB) approach for endoscopic thyroidectomy shows insignificant postoperative complications, except transient vocal cord palsy, as well as good cosmetic results. It is also a feasible method for total thyroidectomy. Therefore, the BAB approach for endoscopic total thyroidectomy can be the surgical treatment of choice for selected cases of thyroid cancer.     

Thyroidectomy Using Pure Natural Orifice Transluminal Endoscopic Surgery in a Porcine Model

Surgical procedures for thyroid disease that provide cosmetically acceptable results are in demand. Natural orifice transluminal endoscopic surgery (NOTES) is performed through natural orifices and thus avoids incision of the body wall. This study aimed to develop an incision‐free surgical procedure for thyroid lobectomy using pure NOTES with an oral approach. In six pig carcasses, an incision was made between the mandible and subcutaneous tissue under direct vision. After subcutaneous dissection and identification of the hyoid bone, the operative field was developed under endoscopic view. After the thyrohyoid membrane was identified, dissection was continued along the thyroid cartilage until the cricoid cartilage was identified and the thyroid isthmus was reached. An original retractor was inserted between dissected tissues to lift and fix the carcass. The thyroid gland was successfully removed through the incision. Similar macroscopic and histological findings were observed on the normal and treated sides, with no damage to the recurrent laryngeal nerves. The times required for securing the operative field and thyroidectomy improved with each operation. This study suggests the feasibility and safety of using pure NOTES for thyroidectomy through a subcutaneous route with an original retractor.     

腔镜甲状腺手术与传统手术创伤的比较研究

目的:比较腔镜甲状腺手术与传统手术对机体损伤的程度。方法:随机将甲状腺疾病患者42例分成两组,腔镜组21例,传统手术组21例。对两组的术中出血量、术后疼痛、血浆炎性因子水平的变化趋势、住院时间、术后3个月颈部感觉情况、吞咽情况等进行比较。结果:腔镜组术中出血(21±14)ml,明显少于传统手术组的(36±18)ml。术后第1天IL-2、IL-6、TNF和术后第2天IL-2水平腔镜组高于传统手术组,差异有统计学意义。术后48、72h腔镜组疼痛比传统手术组轻。术后3个月腔镜组未发生颈部感觉减退,1例吞咽不适,9例有胸骨前紧张感;传统手术组有11例颈部感觉减退或异常,9例吞咽不适,无胸骨前紧张感。腔镜组所有患者对术后美容效果均满意,传统手术组12例对术后美容效果不满意。结论:腔镜甲状腺切除术术中出血少、血浆炎性因子水平较传统手术高,但术后1周内与传统手术组均恢复正常,手术创伤对机体长期影响与传统手术互有优势。     

腔镜与传统甲状腺手术对机体免疫功能的影响

目的比较乳晕入路腔镜和传统开放甲状腺部分切除术对患者免疫功能的影响。方法将50例适合甲状腺部分切除术患者分为腔镜组（n=25）和开放组（n=25）。于术前1天,术后第1天、第2天和第3天分别采集外周静脉血,流式细胞仪检测外周血淋巴细胞亚群（CD3、CD4＋和CD8＋T淋巴细胞比例）,免疫散射比浊法测定免疫球蛋白（IgA、IgG和IgM）,C反应蛋白（CRP）及补体C3、C4含量。结果在腔镜和开放组,CD3、CD8＋T淋巴细胞和补体C4在术后1天较术前均明显下降（P〈0.05）,IgG和补体C3在术后1天和2天较术前均明显下降（P〈0.01）,CRP在术后1天和2天较术前均明显上升（P〈0.05）;但2组间,各免疫指标的变化差异无显著性（P〉0.05）。结论乳晕入路腔镜甲状腺手术和传统开放手术对机体免疫功能均有一定程度的抑制作用,但差异无显著性。     

A Comparison of Postoperative Pain After Conventional Open Thyroidectomy and Transaxillary Single-Incision Robotic Thyroidectomy: A Prospective Study

Background

The aim of this study was to compare conventional open thyroidectomy with robotic thyroidectomy in terms of postoperative pain.

Methods

We compared the intensity of postoperative pain experienced by patients who received conventional open thyroidectomy (n = 45) versus those who underwent robotic thyroidectomy (n = 45). During surgery, we carefully controlled the anesthetic conditions. All the patients underwent a total thyroidectomy with ipsilateral central compartment node dissection. Postoperative pain in the 2 groups was compared using a visual analog scale and the amount of rescue analgesic at 30 min, 4 h, 1, 2, 3, and 10 days after surgery.

Results

The postoperative pain at 30 min and 4 h after surgery were 3.0 ± 0.9 and 2.6 ± 0.9 (p = .066) and 4.9 ± 1.3 and 4.4 ± 1.3 (p = .055) in the conventional open group and the robotic group, respectively. The mean pain scores at 1, 2, 3, and 10 days after surgery were 3.8 ± 1.3 and 3.0 ± 1.3 (p = .001), 2.6 ± 1.2 and 2.0 ± 0.9 (p = .005), 1.7 ± 0.9 and 1.3 ± 0.6 (p = .034), and 0.9 ± 0.7 and 1.2 ± 1.1 (p = .093), respectively. No significant differences were observed between the 2 groups in terms of postoperative rescue analgesic use (1.1 ± 1.1 and 0.8 ± 0.9, p = .264).

Conclusions

Even though robotic thyroidectomy using the transaxillary technique requires a more extensive subcutaneous dissection than conventional open thyroidectomy, robotic thyroidectomy does not result in more postoperative pain or use of analgesic when compared with open thyroidectomy.     

完全腔镜甲状腺手术大出血的处理及防治

目的探讨腔镜甲状腺手术大出血(出血量300 ml)的出血规律及防治要点。方法回顾性分析2002年3月~2014年6月胸乳入路完全腔镜甲状腺手术3812例资料,共发生大出血9例(0.2%),术中出血5例(其中2例有"高气压后暂时不出血"现象),术后出血4例(术后3 h~9 d,其中2例为术后72 h后的迟发性出血)。出血量300~800 ml,平均416.7 ml。结果 9例均手术止血成功。术中出血1例中转开放手术,4例腔镜下止血;术后出血1例行开放手术,3例行腔镜手术。使用超声刀凝固、结扎缝扎套扎血管、切除渗血腺体、加压包扎等方法止血。出血部位为胸壁皮下隧道3例,颈前静脉1例,甲状腺血管3例,甲状腺腺体断面2例。无严重并发症及死亡。结论腔镜甲状腺手术大出血发生率不高,易于发现,可治可防,但其迟发性出血和"高气压后暂时不出血现象"应引起充分重视。