摘要
目的:对比腔镜辅助下(video-assisted thyroidectomy,VAT)与全腔镜甲状腺切除术(total en-doscopic thyroidectomy,TET)的手术特点。方法:回顾性分析行胸骨切迹上径路颈部小切口VAT65例和胸前壁径路TET59例的临床资料。比较2种术式的手术时间、术中失血量、疼痛评分、术后住院时间、并发症和复发率。结果:120例手术成功,4例(VAT和TET组各2例)中转开放手术。VAT组和TET组手术时间分别为(44.15±12.11)min和(115.42±28.36)min,术中失血量分别为(9.54±4.21)mL和(20.68±7.40)mL,疼痛评分分别为3.62±0.93和5.37±0.90,术后住院时间分别为(3.31±0.86)d和(5.31±0.79)d,术后并发症发生率分别为1.54%和15.25%,2组差异均具有统计学意义(P<0.01或P<0.05)。2组术后均无继发出血、永久性声嘶、低血钙等并发症。随访3～37个月,平均17.17个月,复发3例,其中VAT组1例,TET组2例,两组复发率差异无统计学意义(P>0.05)。结论:2种腔镜手术治疗甲状腺良性肿瘤均安全有效。与TET相比,VAT技术难度较低,并发症较少,并具有创伤小、恢复快、术后疼痛轻等优点,是可选择的手术方式之一。
Objective.To compare the total endoscopic thyroidectomy and the video-assisted thyroidectomy, and explore the safety and invasion of the two methods. Methods： 124 cases of benign thyroid diseases were surgically treated from November 2005 to September 2008, including 59 cases of total endoscopic thyroidectomy （TET Group） and 65 cases of video-assisted thyroidectomy （VAT Group）. The operation time, hemorrhage volume, Visual Analogue Scale （VAS） scores for pain severity, postoperative hospital stay, postoperative complication, recurrent rate and reversed operation to open surgery were compared between the two groups respectively, Results ：There were 2 cases converted to open surgery in each group. The mean time of operation was longer for TET patients （44.15 ± 12.11 min in VAT and 115.42 ±28.36 min in TET, P〈0.01）. The mean volume of hemorrhage during operation was 9.54 ± 4.21mL in VAT group and 20.68 ± 7.40 mL in TET group （P〈0.01）. The VAS scores for pain severity, the mean length of postoperative hospital stay and the rate of postoperative complication were significantly higher in the TET group （3.62 ± 0.93 vs 5.37 ± 0.90, P〈0.01; 3.31 ±0.86 d vs 5.31 ± 0.79 d, P〈0.01; 1.54% vs 15.25%, P〈0.05, respectively）. Hemorrhage, permanent hoarseness or hypocalcemia was encountered in neither of the groups. After a median follow-up of 17.17 months （range from 3 to 37 months）,there were 1 case in VAT group and 2 cases in TET group recurred. The recurrent rate between the both groups had no difference （P〉0.05）. Conclusions ：Both the total endoscopic thyroidectomy and the video-assisted thyroidectomy offer a safe therapeutic approach allowing benign thyroid diseases. As compared with the total endoscopic thyroidectomy,the video-assisted thyroidectomy has the advantages of less operation time, minimal invasion, earlier recovery, and less pain. The video-assisted thyroidectomy is another ideal option for benign thyroid diseases.
出处
《中国现代普通外科进展》
CAS
2009年第6期500-503,共4页
Chinese Journal of Current Advances in General Surgery
