改良Miccoli术与经乳晕入路腔镜甲状腺手术对甲状腺微小乳头状癌的治疗效果分析

目的观察改良Miccoli术与经乳晕入路腔镜甲状腺手术对甲状腺微小乳头状癌(PTMC)的治疗效果。 方法回顾性分析2016年1月至2018年6月接受手术治疗的PTMC患者105例资料，根据术式不同分为观察组和对照组，观察组53例行改良Miccoli术式，对照组52例行完全腔镜甲状腺术式，采用SPSS 21.0统计软件对数据进行分析，术中术后各个指标、手术前后PTH、血钙水平、各评分(VAS评分、RSI评分、VHI评分)等以( ±s)表示，采用独立t检验；术后并发症发生率采用χ²检验．以P<0.05为差异有统计学意义。 结果观察组患者手术切口长度、手术时间、术中出血量、术后引流量、颈部恢复活动时间、拔管时间、住院天数均优于对照组(P<0.05)；观察组术后3 d PTH、血钙水平高于对照组(P<0.05)；术后12 h、24 h的VAS评分均小于对照组(P<0.05)；术后3个月VHI评分、美容满意度评分优于对照组(P<0.05)；两组术后并发症发生率差异无统计学意义。 结论改良Miccoli术治疗PTMC效果明显，手术时间短、术中出血量少，术后并发症少，美容效果好，值得临床推广。

Effect of modified Miccoli and transareolar endoscopic thyroidectomy in the treatment of papillary thyroid microcarcinoma

ObjectiveTo observe the therapeutic effect of modified Miccoli and transareolar endoscopic thyroidectomy in the treatment of papillary thyroid microcarcinoma (PTMC). MethodsFrom January 2016 to June 2018, 105 patients with PTMC received surgical treatment were enrolled into present study. who were randomly divided into observation group (53 cases) and control group (52 cases). Patients in observation group received modified Miccoli routine operation, while patients in control group received totally laparoscopic thyroid surgery. Statistical analysis were performed by using SPSS 21.0 software. Measurement data, such as intraoperative all indexes, PTH before and after surgery, postoperative blood calcium levels, and each score (VAS score, RSI grade, VHI) were expressed as( ±s), and were examined by using independent t test. Count data such as incidence of postoperative complication rate were examined by chi square test. A P value <0.05 was considered as statistically significant difference. ResultsThe incision length, operation time, intraoperative blood loss, postoperative drainage volumn, neck recovery time, average extubation time and hospital stay in the observation group were significantly better than those in control group respectively (P<0.05). 3 days after operation, the serum calcium level of PTH in the observation group was higher than that in the control group, with significant difference (P<0.05). The VAS score in the observation group was lower than that in control group at 12 h and 24 h postoperatively (P<0.05). The VHI score and the beauty satisfaction score in the observation group were better than those in the control group respectively (P<0.05). There was no significant difference between the two groups in terms of incidence of postoperative complications ConclusionThe modified Miccoli is effective in the treatment of PTMC with shorter operation time, less intraoperative bleeding, less postoperative complications and better cosmetic effect. It is worth popularizing.