缩小胸壁分离范围的腔镜甲状腺手术与开放手术术后疼痛对比分析

目的：比较缩小胸壁分离范围的腔镜甲状腺手术与开放手术术后的疼痛程度。方法：70例甲状腺疾病患者根据所选手术方式不同分为腔镜组35例（腔镜组采用充分利用Trocar长度,经各切口建立隧道,会师于胸壁上部空间以缩小胸壁分离范围的方法）和开放组35例,用视觉模拟评分法（VAS）评判两组术后1、4 h及1、2、3、5、10 d的疼痛程度,记录两组术后24 h内需要镇痛的患者例数,并行统计分析。结果：两组术后4 h和术后5 d的疼痛程度比较差异无统计学意义（P〉0.05）;腔镜组术后1 h,术后1、2、3 d的疼痛程度较开放组轻,差异有统计学意义（P〈0.05）;腔镜组术后10 d的疼痛程度大于开放组,差异有统计学意义（P〈0.05）。两组术后需要镇痛的患者例数比较差异无统计学意义（P〉0.05）。结论：尽管缩小胸壁分离范围的腔镜甲状腺手术的皮下剥离面积仍大于开放手术,但其术后疼痛程度却较开放组轻,且没有导致术后需要止痛患者例数的增加。

The Comparison of Postoperative Pain after Open Thyroidectomy and Improving-chest-separation-method Endoscopic Thyroidectomy

Objective： To compare the postoperative pain caused by open thyroidectomy and improving-chest- separation-method endoscopic thyroidectomy. Method： 70 patients with thyroid diseases were divided into two groups according to the different ways of operation. The endoscopic group with 35 patients took full advantage of the length of Trocar when separating the skin of chest to create tunnels via each incision to meet at the upper chest space. The conventional group with 35 patients were operated on by conventional open thyroidectomy. The degree of pain at 1, 4 hour, 1, 2, 3, 5, and 10 days postoperatively were measured by Visual Analogue Scale （ VAS ）, and the number of patients who need analgesia in two groups within 24 hours after surgery were count and analyzed. Result： The postoperative pain after 4 hour and 5 days between two groups were not significantly different （/9〉0.05 ）. However, the pain seores in the endoseopic group at 1 h, 1,2, and 3 days after surgery were significantly lower than that in the conventional open group （ P〈0.05 ） . The pain scores in the endoscopic group at 10 days after surgery were significantly higher than that in the conventional open group （ P〈0.05 ） . The number of patients who needed analgesia between the two groups were not significantly different （ P〉0.05 ） . Conclusion： Even though the endoscopic thyroideetomy using the improving chest separation methods requires a more extensive subcutaneous dissection than conventional open thyroideetomy, the endoscopic thyroideetomy using the improving chest separation methods does not result in more postoperative pain or use of analgesic when compared with open thyroideetomy.