无充气经锁骨下入路完全腔镜双侧甲状腺 腺叶手术的效果初探

目的　探讨无充气经锁骨下入路完全腔镜双侧甲状腺腺叶切除术的可行性及安全性。方法　回顾性分析43例双侧甲状腺全切术患者的临床资料。其中13例行无充气经锁骨下入路完全腔镜双侧甲状腺腺叶切除手术（腔镜组），30例行传统开放手术（开放组）。记录2组手术时间、术中出血量、术后引流量、术后第1天甲状旁腺素（PTH）、术后住院时间、手术并发症及美容满意度等。结果　腔镜组患者年龄（46.2±10.1）岁小于开放组（57.4±7.9）岁（P＜0.05）；而2组间性别比例、肿块直径、肿瘤性质差异无统计学意义（P＞0.05）。腔镜组手术时间［（124.2±15.8）min vs. （92.9±9.7）min］及术后引流量［（147.1±42.9）mL vs. （103.7±16.5）mL］均较开放组增多（P＜0.01）；但术中出血量［（26.1±8.5）mL vs. （37.0±10.9）mL］较开放组减少。2组患者术后第1天PTH、住院时间比较差异无统计学意义（P＞0.05）；腔镜组术后美容满意度高于开放组（P＜0.05）。结论　无充气经锁骨下入路完全腔镜双侧甲状腺腺叶切除手术安全、可行，美容效果较佳，值得推广。

Preliminary study on the effect of complete endoscopic bilateral thyroidectomy using the sub-clavian approach

Objective　To explore the feasibility and safety of complete laparoscopy bilateral thyroid lobectomy through subclavian approach without inflation. Methods The clinical data of 43 patients with bilateral total thyroidectomy in the first ward of the First Affiliated Hospital of Bengbu Medical College from December 2019 to April 2020 were retrospectively analyzed. Among them, 13 cases underwent complete laparoscopy bilateral thyroid lobectomy (laparoscopy group) without gas-filled subclavian approach, and 30 cases underwent traditional open surgery (open group). The operation time, intraoperative blood loss, postoperative drainage volume, parathormone (PTH) on the first postoperative day, postoperative hospital stay, surgical complications and cosmetic satisfaction were recorded in the two groups. Results　The age of the laparoscopy group (46.2±10.1) was less than that of the open group (57.4±7.9, P＜0.05). There were no significant differences in gender ratio, tumor diameter and tumor nature between two groups (P＞0.05). The operation time (124.2±15.8) min vs. (92.9±9.7) min] and the amount of drainage fluid (147.1±42.9) mL vs. (103.7±16.5) mL] were higher in the laparoscopy group than those in the open group (P＜0.05). The intraoperative blood loss (26.1±8.5) mL vs. (37.0±10.9) mL] was less in the laparoscopy group than that of the open group. There were no significant differences in hospitalization time and postoperative PTH at first day of operation between the two groups (P＞0.05). The postoperative cosmetic satisfaction was higher in the endoscopic group than that of the open group (P＜0.05). Conclusion　The complete laparoscopy bilateral thyroid lobectomy without air-filled subclavian approach is safe, feasible and has a better cosmetic effect, which is worthy of promotion.