内镜辅助下锁骨下入路手术治疗较大甲状腺良性肿瘤

目的 探讨颈部不遗留手术瘢痕的内镜辅助下较大甲状腺病变处理的新手术方法,评价这种手术的可行性和安全性.方法 2005年4月至2010年1月,中山大学附属第二医院耳鼻咽喉头颈外科对符合入组标准的96例甲状腺良性肿块性疾病患者进行手术治疗.其中采用内镜辅助锁骨下入路手术有42例,简称内镜组(切口取在肿瘤较大的一侧,切口长4～6 cm,位于锁骨下缘,切口内缘距胸正中线≥3 cm).同期本科行传统手术治疗的甲状腺良性肿块患者54例为对照,简称传统组.观察指标为肿物大小、术式、并发症、手术时间、住院时间、切口美容效果.结果 两组在年龄、性别、瘤体大小等方面相匹配.两组中术式分布的情况经比较差异无统计学意义.两组病理结果显示均为良性病变.美容评分显示内镜组美观方面要明显好于传统组(1.6±0.9比5.8±1.2,Z=8.418,P=0.000).随访6个月至4年.内镜组:无永久性声带麻痹;有1例出现暂时性低钙血症,1周恢复;有2例颈部皮肤有紧张感,3个月后减轻;2例发生暂时性声带麻痹,1个月恢复正常.传统组:无永久性声带麻痹,有3例暂时性低钙血症.无气道塌陷导致呼吸困难病例,无复发.两组差异无统计学意义(x2=1.247,P=0.459).结论 采用内镜辅助锁骨下入路可以对≥4 cm或单侧腺体体积≥30ml的甲状腺病变进行处理.

Abstract：

Objective To investigate the endoscopic surgical efficacy of larger benign thyroid tumors and to evaluate its feasibility and safety. Methods Forty-two patients with benign thyroid tumors underwent endoscopic surgery by infraclavicular approach ( a 4 - 6 cm incision on larger side of the tumor ≥3 cm off midline) at our hospital between April 2005 and January 2010. Fifty-four patients were enrolled as controls by conventional approach. Two groups were compared with regards to tumor size, surgical approach,complications, operative duration, hospital stay and incision cosmetic outcomes. Resnlts Two groups were matched by age, sex and tumor size. No statistical significance was found in surgical approach. Pathology examinations proved benign in both groups. The cosmetic results in endoscopic group were obviously favorable than those in conventional group ( 1.6 ±0. 9 vs 5.8 ± 1. 2 ,Z = 8. 418, P =0. 000). All patients were followed up for a period of 6 months to 4 years. Endoscopic group: no permanent glottic paralysis; one patient appeared hypocalcemic and recovered in 1 week; two patients presented with skin tension and alleviated in 3 months; two patients occurred temporary glottic paralysis and recovered in 1 month.Conventional group: no permanent glottic paralysis; three patients appeared temporarily hypocalcemic; no dyspnea from airway collapse; no recurrence. There was no significant distinction between two groups ( x2 =1. 247, P = 0. 459 ). Conclusion Endoscopic surgery by infraclavicular approach is suitable for patients with≥4 cm thyroid tumors.

Endoscopic surgery by infraclavicular approach for larger benign thyroid tumors

Objective To investigate the endoscopic surgical efficacy of larger benign thyroid tumors and to evaluate its feasibility and safety. Methods Forty-two patients with benign thyroid tumors underwent endoscopic surgery by infraclavicular approach ( a 4 - 6 cm incision on larger side of the tumor ≥3 cm off midline) at our hospital between April 2005 and January 2010. Fifty-four patients were enrolled as controls by conventional approach. Two groups were compared with regards to tumor size, surgical approach,complications, operative duration, hospital stay and incision cosmetic outcomes. Resnlts Two groups were matched by age, sex and tumor size. No statistical significance was found in surgical approach. Pathology examinations proved benign in both groups. The cosmetic results in endoscopic group were obviously favorable than those in conventional group ( 1.6 ±0. 9 vs 5.8 ± 1. 2 ,Z = 8. 418, P =0. 000). All patients were followed up for a period of 6 months to 4 years. Endoscopic group: no permanent glottic paralysis; one patient appeared hypocalcemic and recovered in 1 week; two patients presented with skin tension and alleviated in 3 months; two patients occurred temporary glottic paralysis and recovered in 1 month.Conventional group: no permanent glottic paralysis; three patients appeared temporarily hypocalcemic; no dyspnea from airway collapse; no recurrence. There was no significant distinction between two groups ( x2 =1. 247, P = 0. 459 ). Conclusion Endoscopic surgery by infraclavicular approach is suitable for patients with≥4 cm thyroid tumors.