胸骨前入路与锁骨下入路腔镜辅助下甲状腺切除术对比分析

目的：对比胸骨前人路（sternumapproach，S组）与锁骨下入路（infraclavicularapproach，I组）腔镜辅助下甲状腺切除术的手术特点及临床效果。方法：回顾性分析自2010年1月到2011年12月行胸骨前人路（S组）140例和锁骨下入路（I组）45例在腔镜辅助下甲状腺手术的临床资料。比较两种术式的手术时间、术中失血量、术后住院时间、并发症和美容评价。结果：185例均手术成功。S组和I组单侧腺叶次全切除术的手术时间分别为（90．1±10．2）min和（92．2±12．6）min（P〉0．05）；双侧腺叶次全切除术的手术时间分别为（109．3±12．4）rain和（128．5±22．7）min（P〈0．05）。美容评价分别为（9．0±0．2）分和（9．7±0．1）分（P〈0．05）。术中出血量分别为（95．8±11．6）ml和（99．6±21．2）ml（P〉0．05），术后住院时间分别为（5．89±0．88）d和（6．03±0．75）d（P〉0．05）。两组均无中转手术，术后均无并发症。结论：两种入路均安全有效，术后美容效果均较理想。胸骨前入路对双侧叶病灶更易暴露，但美容效果略差。锁骨下入路对于对侧甲状腺病灶暴露欠佳，操作难度增大。

Comparative analysis of video -assisted thyroidectomy with infracla -vicular approach and sternum approach

Objective ：To compare the surgical characteristics of video - assisted thyroidectomy via the sternum approach （group S） and infraclavicular approach （group I）. Methods：From January 2010 to December 2011,185 cases treated with videoassisted thyroidectomy were analysed, including 140 cases of sternum approach（ group S） and 45 cases of infraclavicular approach （ group I）. To compare the surgical operation time, intraoperative blood loss, postoperative hospital stays, and cosmetic evaluation between two groups. Results：Operation of all the cases was completed successfully. The operation time was longer in bilateral subtotal thyroidectomy but the cosmetic evaluation was better for group I （ 109.3 ± 12.4） rain vs （ 128.5 ± 22.7 ） min,P 〈 0.05 ;9.0 ± 0.2 and 9.7 ± 0.1, P 〈 0.05 ]. The intraoperative blood loss was （95.8 ± 11.6） ml in group S and （99.6 ± 21.2） ml in group I （ P 〉 0.05 ）. And the postoperative hospital stay was （5.89 ± 0.88） d and （6.03 ± 0.75 ） d in group S and group I respectively （ P 〉 0.05 ）.There were no conversions to open surgery or any postoperative complications. Conclusion：Both methods were safe and effective for thyroid benign lesions. The cosmetic resuh was satisfied. The sternum approach was better exposed bilateral thyroid lesions ,but the cosmetic result slightly worse than infraclavicular approach. It＇s difficult to expose the contralateral thyroid lesion by infraelavicular approach.