完全腔镜与中转开放甲状腺癌根治术的比较

目的回顾对比分析完全腔镜和中转开放甲状腺癌根治术的临床效果,评价腔镜甲状腺手术适应证扩展的可行性。方法 2001年6月～2008年5月接受腔镜甲状腺手术且术中确诊为甲状腺癌的患者,根据继续腔镜手术或中转开放手术分为腔镜组(15例)和中转组(10例)。手术范围均为患侧腺叶切除+峡部切除+对侧次全切除+中央区淋巴结清扫。回顾性对比分析两组肿瘤直径、手术时间、出血量、中央区淋巴结清扫数量、术后住院时间、手术并发症发生率以及随访结果的差异。结果腔镜组乳头状微小癌(直径<1 cm)的比例显著高于中转组(9/15 vs.1/10,P=0.018),且肿瘤直径显著小于中转组[(1.1±0.6)cm vs.(1.6±0.5)cm,t=-2.132,P=0.045]。2组手术时间、出血量、淋巴结清扫数量和术后住院时间差异无显著性。腔镜组术后24 h疼痛评分显著低于中转组(3.1±1.2 vs.4.6±1.4,t=-2.945,P=0.007),术后3个月美容评分显著高于中转组(7.7±1.1 vs.3.5±1.2,t=9.009,P=0.000)。腔镜组低钙血症2例、暂时性喉返神经麻痹1例,中转组低钙血症1例,均于出院前缓解。2组分别随访(41.5±22.6)月和(46.8±22.3)月,均未见肿瘤复发和转移。结论 对经验丰富,技术熟练的医师,严格选择的甲状腺癌病例可以作为腔镜手术适应证。

Comparison of Total Endoscopic Thyroidectomy with Intraoperative Conversion to Open Thyroidectomy for Thyroid Cancer

Objective To evaluate the efficacy of total endoscopic thyroidectomy and intraoperative conversion to open thyroidectomy,as well as the feasibility of extending surgical indications of endoscopic thyroidectomy for thyroid carcinoma.Methods Between June 2001 and May 2008,25 patients,who underwent endoscopic thyroidectomy in our hospital for thyroid carcinoma,were included in this study.In the patients,endoscopic thyroidectomy was completed in 15 cases(endoscopy group),and the other 10 were converted to open surgery during the endoscopy(conversion group).Both the groups received ipsilateral lobectomy+isthmectomy+cotralateral subtotal lobectomy+central compartment nodes dissection.The mean diameter of the resected tumor,operation time,intraoperative blood loss,number of resected lymph nodes in the central compartment,postoperative hospital stay,rate of postoperative complications,and follow-up results were compared between the two groups. Results The endoscopy group showed significantly higher percentage of papillary micro carcinoma,smaller diameter of the resected tumor,lower 24 h VAS,and higher 3-month cosmetic score than the conversion group [9/15 vs.1=10,P=0.018;(1.1±0.6) cm vs.(1.6±0.5) cm,t=-2.132,P=0.045;3.1±1.2 vs.4.6±1.4,t=-2.945,P=0.007;7.7±1.1 vs.3.5±1.2,t=9.009,P=0.000].No significant difference was detected in the operation time,intraoperative blood loss,number of resected lymph nodes,and postoperative hospital stay.In the endoscopy group,2 patients showed hypocalcemia,and 1 patient developed transient recurrent laryngeal nerve paralysis,while in the conversion group,1 patient developed hypocalcemia;all of them were relieved before being discharged.There was no metastasis or recurrence in the both groups during follow-up [(41.5±22.6) months vs.(46.8±22.3) months].Conclusion For surgeons with sufficient experience on endoscopic thyroidectomy,strictly selected cases could be included in the indications for endoscopic surgery.