摘要
目的观察并比较学习曲线成长阶段、成熟阶段施行经锁骨下免充气腔镜甲状腺手术与开放甲状腺手术的近期临床效果。方法回顾性收集接受甲状腺切除术126例患者的临床资料,其中经锁骨下免充气腔镜甲状腺手术60例(观察组)、开放甲状腺手术66例(对照组)。采用累积和(CUSUM)分析方法拟合经锁骨下免充气甲状腺手术的学习曲线并判定手术学习阶段和成熟阶段。比较两组学习曲线成长阶段、成熟阶段的手术相关指标(如手术整体时间、术中标本离体时间、术后引流量、术中出血量、是否进行甲状旁腺移植等)及术后情况[术后住院时间、住院费用、术后1年复发率和并发症发生情况(低钙血症、甲状旁腺功能减退、暂时性声音嘶哑、术后1年声音嘶哑等)]。结果手术学习曲线最佳拟合方程为CUSUM_(n)=-1.18n^(2)+757+41.59n+185-3n^(3)(R^(2)=0.952,P<0.05),曲线拟合效果良好。观察组学习曲线成长阶段共实施经锁骨下免充气腔镜甲状腺手术20例,对照组同期实施开放甲状腺手术24例;观察组学习曲线成熟阶段共实施经锁骨下免充气腔镜甲状腺手术40例,对照组同期实施开放甲状腺手术42例。观察组成长阶段与成熟阶段的手术时间、甲状腺标本离体时间长于同期对照组,术中出血量少于对照组,术后引流量和甲状旁腺自体移植率高于对照组(P均<0.05)。观察组成熟阶段术后住院时间短于对照组(P<0.01)。两组成长阶段术后并发症发生率差异无统计学意义(P均>0.05);观察组成熟阶段暂时性低钙血症发生率低于对照组(P<0.05)。结论随着手术学习曲线由成长阶段过渡到成熟阶段,与开放甲状腺手术相比,经锁骨下免充气腔镜甲状腺手术具有术中出血量少、术后住院时间短、术后并发症(如暂时性低钙血症)发生率低等优势。
Objective To evaluate and compare the short-term clinical outcomes of gasless trans-subclavian endoscopic thyroidectomy performed during the growth and mature phases of the learning curve with those of conventional open thyroidectomy.Methods A retrospective analysis was conducted on 126 patients who underwent thyroidectomy,including 60 cases of subclavian gasless endoscopic thyroidectomy(observation group)and 66 cases of open thyroidectomy(control group).The learning curve was constructed using cumulative sum(CUSUM)analysis,and the growth and mature phases were identified.Surgical variables(total operative time,specimen extraction time,postoperative drainage,intraoperative blood loss,parathyroid autotransplantation rate)and postoperative outcomes(length of stay,hospital cost,1-year recurrence,complications including hypocalcaemia,hypoparathyroidism,transient vocal cord palsy and persistent dysphonia)were compared between the two groups across both phases.Results The best-fitting equation for the surgical learning curve was CUSUM_(n)=−1.18n^(2)+757+41.59n+185-3n^(3)(R^(2)=0.952,P<0.05),demonstrating a strong fit.During the learning phase,the observation group performed 20 cases of gasless trans-subclavian endoscopic thyroid surgery,while the control group conducted 24 cases of open thyroid surgery in the same timeframe.In the proficient phase,the observation group completed 40 cases,and the control group completed 42 cases.In the learning phase,compared with the control group,the observation group had longer operation time and longer thyroid specimen removal time,less intraoperative blood loss,higher postoperative drainage volumes,and a higher rate of parathyroid autotransplantation(all P<0.05).In the mature phase,the observation group experienced shorter postoperative hospital stay than the control group(P<0.01).There was no statistically significant difference in the rate of postoperative complications between the two groups during the learning phase(all P>0.05).However,in the mature phase,the observation group had a lower incidence of transient hypocalcemia than the control group(P<0.05).Conclusion Over the transition from the growth phase to the mature phase of the learning curve,subclavian gasless endoscopic thyroidectomy confers advantages of reduced intraoperative bleeding,shorter hospitalization and lower morbidity(especially transient hypocalcaemia)in comparison with the open surgery.
作者
翟开开
汪海仪
王筝
匡洁
田远广
伍宏红
ZHAI Kaikai;WANG Haiyi;WANG Zheng;KUANG Jie;TIAN Yuanguang;WU Honghong(Department of Thyroid and Breast Surgery,Tongling Hospital(Tongling People's Hospital)Affiliated to Bengbu Medical University,Tongling 244000,China)
出处
《山东医药》
2025年第12期70-75,共6页
Shandong Medical Journal
基金
安徽省卫生健康委员会科研项目(2024Ab0216)
安徽省教育厅自然科学类重点项目(2024AH051910)
蚌埠医科大学校级自然重大项目(2023byzd002)。
