无注气内镜下甲状腺手术和传统手术的比较研究

目的通过前瞻临床对照研究，评价分析内镜下甲状腺手术组与传统手术组间手术时间、出血量、美容效果、并发症、费用等有无差异，评估技术是否有效、可行、安全。方法2001年7月至2005年10月中山大学附属第二医院耳鼻咽喉头颈外科对83例甲状腺肿瘤的患者施行无注气内镜下甲状腺手术（内镜组），同时对照分析80例在年龄、性别、术式、麻醉、病情轻重、手术医生水平相匹配的本科同期住院行传统手术病例（传统组）。结果内镜组无一例中转手术，美观效果好，颈部仅留小瘢痕或无瘢痕，但住院费用高于传统组，分别为（10844±2373）元和（7585±1081）元，两者比较差异有统计学意义（t=-7．230，P〈0．01）。手术失血量与常规手术相比要少，分别为（25±21）ml和（36±23）ml，两者比较差异有统计学意义（t=3．160，P〈0．01）；但手术时间要长，分别为（107±30）min和（79±19）min，两者比较差异有统计学意义（t=-7．225，P〈0．01）。当术者取得经验和应用先进的超声刀技术后，手术时间和失血量明显减少。结论无注气内镜下甲状腺手术是一个安全有效、可行的新手术，具有美容的优点，为手术治疗甲状腺肿物的患者多提供了一种选择。

Comparative study on gasless endoscopic versus conventional thyroid surgery

OBJECTIVE: To evaluate the efficiency, feasibility and safety of gasless endoscopic thyroid surgery through compared research. METHODS: From July 2001 to Oct. 2005, 83 cases that had received gasless endoscopic thyroid surgery were compared with 80 cases that had received conventional surgery and analyzed on operating time, blood loss, cosmetic effects, complications and costs. RESULTS: Compared with conventional thyroid surgery, endoscopic thyroid surgery group had better cosmetic effects. There was only minimal neck wound or even no neck wound. The cost of hospitalization in the endoscopic group was higher than that in the conventional group (10,844 +/- 2373) RMB and (7585 +/- 1081) RMB respectively (t = -7.23, P < 0.001). The endoscopic group had less blood loss than the conventional group (25 +/- 21) ml and (36 +/- 23) ml respectively (t = 3.160, P < 0.01), but had longer operating time (107 +/- 30) min and(79 +/- 19) min respectively (t = -7.225, P < 0.01). However, when the surgeon had got more experiences and applied the advanced harmonic scalpel, the operative time and blood loss reduced obviously. CONCLUSIONS: Compared with conventional thyroid surgery, gasless endoscopic thyroid surgery has the major advantage that it has cosmetic effect and has small or no scar left on neck. It can be concluded that this technique was efficiency, feasibility and safety. It can offer another choice for the thyroid neoplasms patients.