经胸壁入路内镜甲状腺切除术与开放甲状腺切除术围手术期创伤因素的对比研究

目的:对胸壁入路内镜甲状腺切除术(transthoracic endoscopic thyroidectomy,TET)与传统开放甲状腺切除术(conventional thyroidectomy,CT)的创伤因素进行对比研究,探讨TET技术围手术期的创伤程度。方法:为40例甲状腺结节患者分别行TET及CT,每组各20例。分别检测两组患者术前及术后第1、3天血清中CRP、IL-6、TNF-α、T-淋巴细胞亚群(CD3+,CD4+,CD4+/CD8+)水平;比较两组手术时间、术中出血量、引流量、术后住院时间、并发症;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:TET组无中转常规手术,两组均未发生永久性喉返神经麻痹等严重并发症。两组CRP水平术后24、72h较术前明显升高(P0.01),但组间差异无统计学意义(P0.05)。IL-6、TNF-α、T-淋巴细胞亚群水平手术前后及组间比较差异均无统计学意义(P0.05)。美容满意度TET组明显优于CT组(P0.001)。两组疼痛反应、手术时间、术中出血量、引流量、术后住院时间差异均无统计学意义(P0.05)。结论:TET与传统甲状腺手术相比,手术效果相当,但切口隐蔽,美容效果突出;本研究未发现经胸壁入路甲状腺切除术比传统手术有更严重的创伤反应,其生理和心理创伤总和小于传统手术。     

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.     

内镜辅助的甲状腺切除术

<正>1986年Gagner报告了首例内镜甲状旁腺切除术,系颈部充气建立操作空间,用特制的微小器械完成手术操作。内镜甲状旁腺切除术的开展标志着内镜颈部手术时代的开始,继而出现了经胸壁或腋窝入路,以及经颈前或锁骨下小切口入路内镜辅助甲状腺切除术。内镜辅助的甲状腺切除术(endoscopicassisted thyroidectomy,EAT)或微创电视辅助的甲状腺切除术(minimally invasive video assisted thyroidecto-my,MIVAT)是由意大利比萨大学Miccoli于1988年报道的,其基本术式是经颈部小切口在内镜辅助下完成甲状腺切除。2002年在国内我们较早开展了Miccoli手术。     

经胸乳入路腔镜甲状腺切除术与开放甲状腺切除术的对比研究

目的:对比分析经胸乳入路腔镜甲状腺切除术与开放甲状腺切除术的临床疗效。方法:回顾分析2010年8月至2013年10月收治的135例甲状腺手术患者的临床资料,根据患者要求分为腔镜组(n=76)与开放手术组(n=59),比较分析两组患者术中及术后情况。结果:两组住院时间、住院费用差异无统计学意义(P>0.05);手术时间、术中失血量、术后引流量及术后镇痛时间两组差异有统计学意义(P<0.05)。结论:腔镜甲状腺切除术具有传统手术无法比拟的优势,术中失血量少,术后疼痛轻微,美容效果好,可充分满足广大女性患者的美容需求,手术安全、可行,值得推广应用。     

经腋乳入路机器人与腔镜甲状腺切除术近期 疗效的对比研究

目的:探讨经腋下双侧乳晕径路行机器人甲状腺切除术的可行性及临床疗效。方法:回顾分析2017年9月至2018年4月行甲状腺切除术的87例患者的临床资料,其中40例行腔镜甲状腺切除术(腔镜组),47例行机器人甲状腺切除术(机器人组)。对比两组手术时间、术中出血量、术后引流量、引流时间、术后住院时间、并发症等相关指标。结果:机器人组手术时间[(121.3±27.3)min vs.(136.1±23.9)min,t=-2.650,P=0.011]短于腔镜组,术中出血量[(14.2±7.9)mL vs.(18.8±12.0)mL,t=-2.138,P=0.035]少于腔镜组,差异有统计学意义(P<0.05),两组术后引流总量、引流时间、术后住院时间、并发症发生率差异无统计学意义(P>0.05)。结论:达芬奇机器人甲状腺切除术安全、可行,美容效果令人满意,具有良好的应用前景,是可供选择的甲状腺切除术式。     

前胸入路内镜下甲状腺大部切除术探讨

目的 探讨内镜下甲状腺大部切除术治疗甲状腺良性肿瘤新手术方法的可行性。方法对3例甲状腺良性肿瘤，经前胸壁入路行内镜下甲状腺大部切除术。结果 3例均获成功，平均手术时间148min，未发生并发症，术后平均3．3天出院。结论 前胸入路内镜下甲状腺大部切除术是可行的，达到了微创，美容效果。但手术时间长，费用相对高。     

完全内镜双侧乳晕同侧腋窝径路甲状腺切除术的临床应用

目的:探讨完全内镜双侧乳晕同侧腋窝径路甲状腺切除术手术(ABBA)的临床效果,并与内镜乳晕胸壁径路甲状腺切除术手术(BAET)进行对比研究。方法:回顾性分析2015年8月—2017年8月138例同一手术者行内镜单侧甲状腺切除术的临床资料,其中行ABBA术54例(ABBA组),行BAET术84例(BAET组)。比较两组的手术时间、出血量、手术分离皮瓣的面积、术后第1天引流量、术后住院时间、术后第1天VAS疼痛评分、术后并发症、术后第1天C?反应蛋白(CRP)。结果:两组的年龄、手术时间、出血量、术后第1天引流量、肿瘤大小比较无统计学差异(P0.05)。ABBA组与BAET组的手术时间、出血量、分离皮瓣面积、术后第1天VAS评分、术后并发症、术后第1天CRP及术后住院时间等指标比较均无统计学差异(P0.05),随访4~24个月,BAET组18例胸前有疤痕疙瘩,ABBA组对切口美容效果满意。结论:ABBA与常用BAET相比,具有同样的临床效果,是安全可行的,ABBA避免可以胸前的手术疤痕,具有更好的切口美容效果。     

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。     

锁骨上径路与胸壁径路甲状腺内镜手术临床效果比较

目的比较锁骨上径路与胸壁径路甲状腺内镜手术临床疗效。方法回顾性分析2011年1月至2014年6月50例锁骨上径路甲状腺切除术(锁骨组)和50例胸壁径路甲状腺内镜手术(胸壁组)的临床资料。采用SPSS20.0软件分析,手术时间、结节大小、术中失血量、引流量、血清CRP、住院天数、疼痛水平和复诊时外观满意度等计量资料以x珋±s表示,采用t检验;局部麻醉比例、术后并发症发生率等计数资料采用χ2检验。P0.05为差异具有统计学意义。结果锁骨组患者手术时间显著低于胸壁组(t=4.325,P0.01),局部麻醉比例、结节大小显著高于胸壁组(χ2=31.579,t=3.536,P0.01),术中失血量显著高于胸壁组(t=2.254,P0.05);术后疼痛水平和复诊时外观满意度强于胸壁组(t=1.705,t=2.166,P0.05)差异均有统计学意义。术后引流量、血清CRP、住院天数、并发症发生率两组差异无统计学意义。结论锁骨上径路手术与胸壁径路甲状腺腹内镜手术相比操作简单、适应证广但美容效果较差,临床上应根据患者病情选择合适术式。     

经胸壁入路腔镜甲状腺切除术与开放手术的临床对比分析

目的：比较完全腔镜与常规开放甲状腺切除术之间的差别,探讨腔镜下甲状腺手术的可行性和实用性。方法选择甲状腺良性肿瘤130例,随机分为经胸壁入路腔镜甲状腺切除术58例（腔镜组）和开放切除术72例（开放组）。观察比较两组手术时间、术中出血量、术后住院时间、术后引流量、引流时间、住院费用、术后美容效果、术后并发症发生情况、术后疼痛评分及患者满意度等。结果开放组住院时间、切口长度显著多（长）于腔镜组（P ＜0．05）,出血量、手术时间、拔管时间、住院费用、引流量、术后疼痛 VAS 分值显著少（短）于腔镜组（P ＜0．05）。两组术后并发症发生率、肿瘤复发率比较,差异无统计学意义。腔镜组患者美观满意度显著高于开放组（P ＜0．05）。结论经胸壁入路腔镜甲状腺切除术临床效果优于开放切除术,在严格把握手术适应证的情况下是值得推崇的手术方式。     

全内镜下甲状腺切除术治疗分化型甲状腺癌25例

目的 总结全内镜下甲状腺切除术治疗分化型甲状腺癌的经验并评估其治疗效果.方法 回顾性分析自2004年11月至2009年7月行乳晕腋窝入路全内镜下甲状腺癌手术25例患者的临床资料. 结果全部25例患者均在全内镜下成功实施甲状腺根治性手术,11例行患侧腺叶全切,14例行患侧腺叶全切加峡部及对侧腺叶大部分切除;7例术中清扫淋巴结.术后病理诊断均证实为分化型甲状腺癌(乳头状癌23例,滤泡状癌2例),中位随访时间28.0月(5～58月),无手术并发症,无复发病例,全部患者对美容效果满意.结论 内镜下甲状腺切除手术治疗分化型甲状腺癌是一种兼顾安全性,可行性及美容性的方法.     

经胸乳入路全腔镜甲状腺手术的临床应用（附112例分析）

目的：探讨全腔镜甲状腺手术的临床应用价值。方法回顾性分析2012年2月至2013年5月112例全腔镜甲状腺手术及115例开放甲状腺手术患者的临床资料。结果112例全腔镜甲状腺手术中3例因术后病检切片报告为恶性行二次开放手术,其余109例顺利完成手术,手术时间（105．6±43．3）min,115例开放手术时间（81．3±35．5）min,两者差异有统计学意义（P ＜0．05）;术后引流量、手术并发症两者差异无统计学意义;术后外观满意度、术后平均住院时间两者差异有统计学意义（P ＜0．05）。结论有开放甲状腺手术经验的外科医师容易掌握全腔镜甲状腺手术,其中有一个学习曲线过程;全腔镜甲状腺手术具有较好的美容效果,对于一定人群有较大的应用价值。     

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??Prevention and treatment of complications in totally endoscopic thyroidectomy WANG Ping, XIE Qiu-ping. Department of Thyroid Surgery, the Second Affiliated Hospital of Zhejiang University, Hangzhou 310009,China
Corresponding author??WANG Ping,E-mail??p.wang_zju@foxmail.com
Abstract Totally endocsopic thyroidectomy??TET????as a new procedure for thyroid disease??has been wildly welcomed by thyroid surgeons and patients due to its perfect cosmetic benefits and relatively simple manipulations.The most usual approach is transbreast and transoral in China. The complications of TET are different from open thyroidectomy??OT????and the novice and inexperienced are prone to have complications. Strictly controlled surgical indications, normatively regulated training of practitioners should be strengthened. It is the key to prevent and cure serious complications, that operators should have experienced OT and endoscopic techniques. The application of high definition equipment and fine equipment will be more helpful for the improvement of TET security, will make TET better than OT eventually someday.     

Comparison of total endoscopic thyroidectomy with conventional open thyroidectomy for treatment of papillary thyroid cancer: a systematic review and meta-analysis

Despite the fact that thyroid surgery has evolved towards minimal incisions and endoscopic approaches, the role of total endoscopic thyroidectomy (TET) in thyroid cancer has been highly disputed. We performed a systematic review and meta-analyses of peer reviewed studies in order to evaluate the safety and effectiveness of TET compared with conventional open thyroidectomy (COT) in papillary thyroid cancer (PTC). Medical literature databases such as PubMed, Embase, the Cochrane Library, and Web of science were systematically searched for articles that compared TET and COT in PTC treatment from database inception until March 2019. The quality of the studies included in the review was evaluated using the Downs and Black scale using Review Manager software Stata V.13.0 for the meta-analysis. The systematic review and meta-analysis were based on 5664 cases selected from twenty publications. Criteria used to determine surgical completeness included postoperative thyroglobulin (TG) levels, recurrence of the tumor after long-term follow-up. Adverse event and complication rate scores included transient recurrent laryngeal nerve (RLN) palsy, permanent RLN palsy, transient hypocalcaemia, permanent hypocalcaemia, operative time, number of removed lymph nodes, length of hospital stay and patient cosmetic satisfaction. TET was found to be generally equivalent to COT in terms of surgical completeness and adverse event rate, although TET resulted in lower levels of transient hypocalcemia (OR 1.66; p < 0.05), a smaller number of the retrieved lymph nodes (WMD 0.46; p < 0.05), and better cosmetic satisfaction (WMD 1.73; p < 0.05). COT was associated with a shorter operation time (WMD − 50.28; p < 0.05) and lower rates of transient RLN palsy (OR 0.41; p < 0.05). The results show that in terms of safety and efficacy, TET was similar to COT for the treatment of thyroid cancer. Indeed, the tumor recurrence rates and the level of surgical completeness in TET are similar to those obtained for COT. TET was associated with significantly lower levels of transient hypocalcemia and better cosmetic satisfaction, and thus is the better option for patients with cosmetic concerns. Overall, randomized clinical trials and studies with larger patient cohorts and long-term follow-up data are required to further demonstrate the value of the TET.     

全腔镜甲状腺手术并发症及防治

全腔镜甲状腺手术（TET）具有手术操作相对简单、美容效果好等特点,目前最常用的入路方式是经胸前入路及经口入路,两种方式都已逐渐为甲状腺外科医生及病人接受。但开展手术的医院和医生的水平参差不齐,新手及经验不足者,容易引起各种并发症。而TET与传统开放手术（OT）相关并发症及防治措施不尽相同。对于TET并发症的防治,应严格掌握手术适应证,加强从业医师的培训。术者要求兼备OT手术经验及腔镜操作技巧,具有果断适时中转的决断,是防治严重并发症的关键。而高清设备及精细器械的应用将更有助于TET安全性的提高,甚至可优于OT。     

基于CT定量心外膜脂肪组织与冠状动脉疾病的关系:Meta分析

目的 采用Meta分析评价CT定量心外膜脂肪组织（EAT）与冠状动脉疾病（CAD）的相关性。方法 检索中国知网、万方医学网、维普网及PubMed、Web of science、Medline数据库中自建库至2019年12月31日关于CT定量EAT与CAD相关性的病例对照研究,以Stata 12.0软件分析CAD组与非CAD组之间标准化均数差（SMD）及95% CI。结果 纳入19篇文献,CAD组5 129例,非CAD组7 434例;CAD组EAT厚度[SMD=0.46,95% CI（0.26,0.66）,P<0.01）]和容积[SMD=0.65,95% CI（0.46,0.86）,P<0.01）]均大于非CAD组。结论 CT定量EAT与CAD存在相关性。     

Benefits and limits of minimally invasive techniques in thyroid surgery

The present study was designed to investigate the potential benefits and limits of two minimally invasive thyroidectomy procedures, namely minimally invasive video-assisted thyroidectomy (MIVAT) and open minimal-incision thyroidectomy (MIT). From May 2000 to June 2006, a prospective, non-randomised study was performed on 957 consecutive patients undergoing thyroid surgery. Fifty-six (5.8%) underwent MIVAT, 214 (22.4%) MIT and 687 (71.8%) conventional thyroidectomy (CT). Patients were selected for MIVAT when total thyroid volume was < or = 30 mL and for MIT when total thyroid volume was > 30 but < or = 80 mL, as determined by ultrasonography. The length of the central neck skin incision was 1.5-2 cm for MIVAT, 2.5-3.5 cm for MIT and 6-10 cm for CT. The incidence of definitive hypoparathyroidism or recurrent laryngeal palsy after MIVAT or MIT was comparable to that occurring after CT. Patients undergoing MIVAT or MIT experienced significantly less postoperative pain than those undergoing CT. Less pain was also registered in the MIVAT patient cohort as compared to the MIT group. Patients undergoing MIVAT or MIT were more satisfied with the cosmetic result as compared to those undergoing CT, whereas no significant differences were found between the MIVAT and MIT groups. As compared to CT, MIVAT and MIT provided a significant improvement in terms of cosmetic results and postoperative pain. Nevertheless, the main limiting factor for minimally invasive thyroid surgery still remains the size of the thyroid.     

Comparison of serum calcium change following thyroid and nonthyroid neck surgery

OBJECTIVE: Compare serum calcium changes following thyroid and nonthyroid/parathyroid neck surgery. STUDY DESIGN: Controlled historic cohort study of 190 patients undergoing total thyroidectomy (TT, n = 97), completion thyroidectomy (CT, n = 27), and lateral neck dissection (ND, n = 66). RESULTS: Each group experienced significant corrected serum calcium drop pre-op to POD #1 (mean change (mg/dL) TT = 0.97, CT = 0.79, ND = 0.46; all P < 0.001) with significantly greater drop in TT and CT (P < 0.0001). TT and ND had significantly greater calcium drop from pre-op to PACU than CT (0.54, 0.43, 0.15; P = 0.04). TT and CT experienced significantly greater calcium drop from PACU to POD #1 than ND (0.45, 0.53, 0.05; P < 0.0001). No significant difference in hypocalcemia rate between TT and CT. CONCLUSIONS: Perioperative calcium drop in nonthyroid neck surgery is likely hemodilutional, occurring intraoperatively, whereas in thyroid surgery it likely results from both hemodilution and parathyroid dysfunction with the latter manifesting after PACU. Postoperative calcium monitoring should be similar following total and completion thyroidectomy due to similar rates of hypocalcemia and mean calcium drops. EBM rating: B-3b.