摘要
目的探讨经胸前入路腔镜甲状腺手术在甲状腺外科手术应用中的安全性及有效性。方法回顾性分析2018年3月—2019年8月河南中医院大学第一附属医院行手术治疗的230例甲状腺肿瘤患者的病历资料,男性67例,女性163例,年龄19~71岁。根据手术方式将患者分为传统手术组(n=95)及经胸前入路腔镜手术组(腔镜组,n=135)。比较两组患者术前一般资料情况和术中手术时间、肿物切除时间、术中出血量,以及术后引流量、拔管时间、住院时间、声音嘶哑、术后出血、切口感染、麻木抽搐、满意度等相关指标。采用SPSS22.0软件进行统计学分析。正态分布的计量资料以均数±标准差(Mean±SD)表示,组间比较采用t检验或χ^2检验。非正态分布资料用中位数M(P25,P75)表示,组间比较采用Mann-Whitney U检验。频数T<1的采用Fisher精确检验。结果术前一般资料相比,传统组结节的数目3.00(2.00,3.00)个,腔镜组结节的数目2.00(1.00,3.00)个,差异有统计学意义(Z=-4.461,P<0.01)。传统组肿物最大直径1.00(1.00,2.00)cm,腔镜组肿物最大直径1.00(1.00,2.00)cm,两者比较有统计学意义(Z=-2.041,P=0.041),其余指标,如年龄、性别、病程、结节类型、囊性变、结节位置、纵横比、结节回声、结节形态、结节钙化等差异均无统计学意义(P均>0.05)。术中指标比较,传统组手术时间较腔镜组短[(67.51±9.27)min比(89.86±10.32)min,t=11.462,P<0.01];传统组肿物切除时间也较腔镜组短[(28.37±8.94)min比(33.35±7.39)min,t=5.456,P<0.01];传统组术中出血量明显多于腔镜组[(51.34±3.26)ml比(20.65±5.89)ml,t=14.723,P<0.01]。两组术中均探查喉返神经,探查率均为100%、两组麻醉情况均良好、两组引流管均留置。术后传统组引流量明显高于腔镜组[(135.76±60.55)ml比(69.12±37.13)ml,t=10.805,P<0.01]。传统组拔管时间和住院时间都长于腔镜组[(5.54±1.44)d比(4.66±1.55)d,t=2.384,P=0.023;(10.48±5.37)d比(7.25±3.68)d,t=11.549,P<0.01]。传统组声音嘶哑11例,腔镜组声音嘶哑4例,差异有统计学意义(χ^2=6.790,P=0.009);传统组术后出血5例,腔镜组术后出血1例,差异有统计学意义(χ。2=4.365,P=0.037);传统组切口感染5例,腔镜组切口感染0例,差异有统计学意义(P=0.012);传统组麻木抽搐4例,腔镜组0例,差异有统计学意义(P=0.028);传统组满意87例,腔镜组满意134例,差异有统计学意义(χ^2=6.825,P=0.009)。结论经胸前入路腔镜甲状腺手术在甲状腺外科手术应用并发症少,术后康复快,值得广泛推广,但具体实施方案还有待进一步优化。
Objective To explore the safety and effectiveness of transthoracic endoscopic thyroid surgery in thyroid surgery.Methods Retrospectively analyzed 230 patients with thyroid tumor aged from 19 to 71 years,including 67 males and 163 females,who were admitted to General minimally invasive surgery,First Affiliated Hospital of Henan University of Chinese Medicine from March 2018 to August 2019.All patients were divided into traditional operation group(n=95)and endoscopic group(n=135)according to the operation method.The general information of the two groups of patients before surgery,including the time of surgery and tumor removal,amount of bleeding during surgery,postoperative drainage and extubation time,were compared.And the hospital stay,hoarseness,postoperative bleeding,incision infection,numbness,twitching,satisfaction and other related indicators were calculated also.SPSS 22.0 software was used for statistical analysis.Normally distributed measurement data were expressed as Mean±SD,and conparisons between groups were calculated by t test orχ^2 test.The non-normally distributed data were expressed as M(P25,P75)and were analyzed by the Mann-Whitney U test.Results Compared with the preoperative general data,the number of nodules in the traditional group was 3.00(2.00,3.00),and the number of nodules in the endoscope group was 2.00(1.00,3.00).The difference was statistically significant(Z=-4.461,P<0.01).The maximum diameter of the tumor in the traditional group is 1.00(1.00,2.00)cm,and the maximum diameter of the tumor in the endoscope group is 1.00(1.00,2.00)cm.The two are statistically significant(Z=-2.041,P=0.041).There were no significant differences in age,gender,course of disease,nodule type,cystic change,nodule location,aspect ratio,nodule echo,nodular morphology,and nodular calcification(all P>0.05).Comparison of intraoperative indicators,the operation time of the traditional group was shorter than that of the endoscope group[(67.51±9.27)min vs(89.86±10.32)min,t=11.462,P<0.01];the tumor removal time of the traditional group was also shorter than that of the endoscope group[(28.37±8.94)min vs(33.35±7.39)min,t=5.456,P<0.01];the blood loss in the traditional group was significantly more than that in the endoscope group[(51.34±3.26)ml vs(20.65±5.89)ml,t=14.723,P<0.01].The recurrent laryngeal nerve was explored intraoperatively in both groups with a detection rate of 100%,the anesthesia was good in both groups,and the drainage tubes were indwelling in both groups.The drainage volume of the traditional group was significantly higher than that of the endoscope group[(135.76±60.55)ml vs(69.12±37.13)ml,t=10.805,P<0.01].The extubation time was longer in the traditional group than in the endoscope group[(5.54±1.44)d vs(4.66±1.55)d,t=2.384,P=0.023].In terms of hospitalization time,the traditional group was significantly longer than the endoscope group[(10.48±5.37)d vs(7.25±3.68)d,t=11.549,P<0.01].There were 11 cases of hoarseness in the traditional group and 4 cases of hoarseness in the endoscope group,and there has statistically significant(χ^2=6.790,P=0.009).There were 5 cases of postoperative bleeding in the traditional group,1 case of postoperative bleeding in the endoscope group,the difference between the two was statistically significant(χ^2=4.365,P=0.037);5 cases of incision infection in the traditional group,none in the endoscope group,and the difference was statistically significant(P=0.012);4 cases of numbness convulsions in the traditional group,none in the endoscope group,and there was statistical significance(P=0.028);87 cases of satisfaction in the traditional group,and 134 cases of satisfaction in the endoscope group,and the difference was statistically significant(χ^2=6.825,P=0.009).Conclusions Transthoracic endoscopic thyroid surgery has fewer complications in thyroid surgery and quicker postoperative recovery.It is worthy of widespread promotion,but the specific implementation plan needs to be further optimized.
作者
孙维义
张楠
张静蕾
张兆宏
黄晶晶
赵媛媛
郅强
Sun Weiyi;Zhang Nan;Zhang Jinglei;Zhang Zhaohong;Huang Jingjing;Zhao Yuanyuan;Zhi Qiang(Henan University of Traditional Chinese Medicine,Zhengzhou 450046,China;General minimally invasive surgery,the First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450004,China;Zhengzhou University,Zhengzhou 450001,China)
出处
《国际外科学杂志》
2019年第12期840-845,共6页
International Journal of Surgery
基金
河南省科技攻关项目(182102310306)。
关键词
甲状腺
外科手术
康复
治疗结果
Thyroid gland
Surgical procedures
operative
Endoscope
Treatment outcome
