经胸乳入路腔镜甲状腺手术与传统甲状腺手术的疗效对比

目的:对比经胸乳入路腔镜甲状腺手术与传统甲状腺手术的临床疗效，探讨经胸乳入路腔镜甲状腺手术的可行性和优势。方法:回顾性分析了2011年12月至2014年3月收治的314例接受手术治疗的甲状腺良性肿瘤患者的临床资料，其中腔镜组78例，行经胸乳入路腔镜甲状腺手术；开放组236例，行传统开放性甲状腺手术。采用统计学方法对两组手术时间、术中出血量、术后第一天引流量、使用止痛药物情况、术后并发症、术后住院时间情况进行对比分析，并进行术后随访。结果:腔镜组手术时间为(82.0±23.5)min，长于开放组(57.7±13.7)min，差异有统计学意义（P＜0.01)；腔镜组术中出血量（13.9±7.6）ml低于开放组（33.9±15.4)ml，差异有统计学意义(P＜0.01)；术后第一天出血量(22.3±8.7)ml少于开放组（36.0±17.8）ml，差异有统计学意义（P＜0.01)；术后住院时间分别为（2.4±0.9）天和（3.6±1.2）天，差异有统计学意义（P＜0.01)；腔镜组患者术后使用止痛药的比例小于开放组；腔镜组术后无严重并发症，并发症发生率与开放组无差异且均较低，术后随访半年，未出现甲状腺功能减退和复发。结论:经胸乳入路腔镜甲状腺手术是一种安全、可靠的手术方式，具有出血少、住院时间短、疼痛轻和颈部无疤痕等优势。

Comparative study between conventional open thyroidectomy and endoscopic thyroidec-tomy by trans -thoracoareolar approach

Objective:To compare the clinical efficiency of endoscopic thyroidectomy by trans-thoracoareolar approach with conventional open thyroidectomy,to explore the feasibility and advantage of endoscopic thyroidectomy.Methods:The clinical data of 314 cases of benign thyroid tumor patients who treated with surgery from December 2011 to March 2014 were analyzed retrospectively(endoscopy group:78 cases of endoscopic thyroidectomy by trans-thoracoareolar approach,open group:236 cases of conventional open thyroidectomy,).Operative time,blood loss,the volume of drainage in the first day after operation,use of painkillers,postoperative complications,time of postoperative stay and postoperative follow-up studies were compared.Results:The operation time in group endoscopy was(82.0±23.5)min,longer than open group(57.7±13.7)min,the difference was statistically significant(P＜0.05).The blood loss of endoscopy group was （13.9±7.6）ml,much less than the open group（33.9±15.4)ml,the difference was statistically significant(P＜0.01).The volume of drainage in the first day after operation of group endoscopy was(22.3±8.7)ml,less than open group（36.0±17.8）ml,the difference was significant(P＜0.01).The postoperative stay of endoscopy group was(2.4±0.9)d,less than open group(3.6±1.2)d,the difference was significant(P＜0.01).The use of painkillers in endoscopy group was less than open group.The postoperative complications，time of postoperative stay and postoperative follow-up studies were both low in the two groups,and the differences were not statistically significant.Conclusion:Endoscopic thyroidectomy by trans-thoracoareolar approach is a safe and feasible method.The advantages of endoscopic thyroidectomy by trans-thoracoareolar approach were less blood loss,less time of postoperative stay,less pain and no scar on the neck.