腹腔镜下改良淋巴结清扫术在甲状腺癌中的应用价值

目的探究腹腔镜下改良淋巴结清扫术在甲状腺癌中的临床价值。方法以2011年6月至2015年5月接受医治的90例甲状腺乳头状癌(PTC)患者为研究对象。根据医治方法的不同分成腹腔镜组(35例)和传统手术组(55例)。统计学分析采用SPSS 19.0软件,对两组患者手术时间、术中出血量、术后总引流量、总住院时间用(x珋±s)表示,使用t检验;并发症比较采用χ2检验及Fisher确切概率法分析,P值小于0.05为差异有统计学意义。结果腹腔镜组在手术用时较传统组要长,但术中出血量却较传统组少[(30.13±11.25)ml比(49.49±12.13)ml(t=7.589,P0.05)];术后腹腔镜组引流量较传统组多[(92.38±21.35)ml比(42.85±18.73)ml(t=11.579,P0.05)];住院时间腹腔镜组短于传统组[(4.47±0.53)d比(7.32±1.52)d(t=10.669,P0.05)];腹腔镜组与传统组在术中淋巴结清扫数目上没有明显差别[(5.32±1.21)个比(4.95±1.72)个(P0.05)];术后并发症总发生率:腹腔镜组8.57%(3/35)少于传统组25.45%(14/55),差异有统计学意义(χ~2=3.979,P=0.046)。结论腹腔镜下改良淋巴结清扫术医治PTC安全可行,具有术中出血量少、术后疼痛轻及术后恢复快等优点,值得临床推广应用。

Clinical application of modified laparoscopic lymph node dissection in thyroid carcinoma surgery

Objective To evaluate the clinical value of modified laparoscopic lymph node dissection in thyroid carcinoma surgery . Methods From June 2011 to May 2015, clinical data of 90 patients who received lymph node dissection in thyroid carcinoma surgery were analyzed retrospectively .Patients in the traditional group (55 cases) were treated with conventional operation , while patients in the laparoscopic group (35 cases) were treated with laparoscopic operation .Statistical analysis was performed by using SPSS 19.0 software.Measurement data were expressed as (x±s), including operation time, intraoperative blood loss, postoperative amount of drainage and hospital stay , and were examined by using t test.Complications were compared by using chi-square test and Fisher ’ s exact probability analysis method .A P value less than 0.05 was considered as significant difference . Results The laparoscopic group had longer operation time than that of traditional group , but the amount of blood loss was less than that of the traditional group [ ( 30.13 ± 11.25) ml vs (49.49 ±12.13) ml (t=7.589, P<0.05)].The drainage volume of the laparoscopic group was significantly more than that of the traditional group [(92.38 ±21.35) ml vs (42.85 ±18.73) ml ( t=11.579, P<0.05)].The length of postoperative hospital stay of the traditional group was significantly longer than that of the laparoscopic group[(7.32 ±1.52) d vs (4.47 ±0.53) d (t=10.669, P<0.05)].The number of harvested lymph nodes of the two group were similar[(5.32 ±1.21) vs (4.95 ±1.72) (P>0.05)];The overall complication rate in laparoscopic group 8.57%(3/35) was less than 25.45%(14/55) of the conventional group, with significant difference (χ2 =3.979, P =0.046). Conclusion Compared with open thyroidectomy, laparoscopic lymph node dissection in thyroid carcinoma surgeryhas the advantages of less intraoperative blood loss, less pain, better cosmetic effect.It is safe, feasible and worth of wider application.