两种不同切口腔镜甲状腺手术与开放甲状腺手术的临床对照研究

目的：探讨全乳晕入路及胸乳入路腔镜甲状腺手术的临床效果及安全性。方法回顾性分析开放甲状腺手术59例（开放组），胸乳入路腔镜甲状腺手术76例（胸乳组），全乳晕入路腔镜甲状腺手术122例（全乳晕组），比较各组年龄、手术时间、术中出血量、术后第1天引流量、术后住院时间、并发症发生率、疼痛视觉模拟评分（ VAS ）、术后满意率和美容效果评定。结果各组术中出血量及术后住院时间差异无统计学意义。腔镜组中胸乳组和全乳晕组手术时间（（103.5±26.2）min vs（108.1±23.9）min）、术后第1天引流量（（106.5±31.0）ml vs（117.4±38.8）ml），显著高于开放组（（65.3±22.4）min及（50.5±23.8）ml）（P值均＜0.05）。术后分析显示各组并发症发生率无统计学意义。术后第1天腔镜手术2组患者疼痛视觉模拟评分（2.8±0.4 vs2.9±0.4）显著低于开放组（3.8±0.6）（P值均＜0.05），术后第2、3天各组疼痛视觉模拟评分无统计学意义。术后各时间点腔镜手术患者满意率及美容效果评定均显著高于开放组（P值均＜0.05）。进一步分析显示，术后90 d全乳晕入路患者满意率96.7％及美容效果评定8.8±0.9均显著高于胸乳入路患者（92.1％及7.3±0.7）（P值均＜0.05）。结论腔镜下甲状腺手术安全可行。经全乳晕入路腔镜甲状腺手术远期满意率高，美容效果好，是甲状腺手术的理想术式。

A comparison study of endoscopic thyroidectomy via two different incisions and open thyroidectomy

Objective To evaluate the clinical benefits and safety of endoscopic thyroidectomy via bilat -eral-nipple approach and breast approach by comparison with conventional open thyroidectomy .Methods 59 pa-tients undergoing open thyroidectomy , 76 patients undergoing endoscopic thyroidectomy via breast approach , and 122 patients undergoing endoscopic thyroidectomy via bilateral-nipple approach were retrospectively analyzed . Patients＆#39;age, operation duration, intraoperative blood loss, the first day drainage volume after operation , postop-erative hospital stay , the incidence of complications , pain visual analogue score （ VAS） , postoperative satisfaction rate as well as the evaluation of cosmetic results were compared among different groups .Results No significant difference was observed in the intraoperative blood loss and the postoperative hospital stay among different groups . The operation duration and the first day drainage volume after operation in the endoscopic thyroidectomy groups （（103.5 ±26.2）min vs （108.1 ±23.9）min,（106.5 ±31.0）ml vs （117.4 ±38.8）ml）were significantly high-er than those in the open thyroidectomy group（（65.3 ±22.4）min and （50.5 ±23.8）ml）（P〈0.05, respective-ly）.No significant difference was observed in the complication incidence among different groups .On the first day after operation, VAS of the endoscopic thyroidectomy groups （2.8 ±0.4 vs 2.9 ±0.4）was significantly lower than that of the open thyroidectomy group（3.8 ±0.6）（P〈0.05, respectively）, even though on the second and the third day no significant difference was observed among different groups .Besides, postoperative satisfaction rate and the evaluation of cosmetic results in endoscopic thyroidectomy groups were significantly higher than those in the open group（P〈0.05, respectively）.Furthermore, 90 days after operation, the satisfaction rate and the eval-uation of cosmetic results in the endoscopic thyroidectomy group through bilateral -nipple approach （