摘要
目的:探讨经胸乳入路腔镜甲状腺微小乳头状癌切除术与传统开放手术的临床效果、安全性及卫生经济学。方法:回顾分析2018年9月至2020年8月收治的44例甲状腺微小乳头状癌患者的临床资料,其中21例(腔镜组)行经胸乳入路腔镜甲状腺微小乳头状癌切除术,23例(开放组)行甲状腺微小乳头状癌传统开放手术,对比分析两组患者性别、年龄、病理肿瘤最大径、肿瘤数量、肿瘤侧别、是否合并桥本氏甲状腺炎等一般资料,手术时间、术中出血量、淋巴结清扫数量、总引流量、拔除引流管时间、术后住院时间、手术费用、总费用、术后并发症等指标;采用视觉模拟评分法评估患者术后第1天疼痛程度;采用调查问卷的形式评估术后3个月切口美容满意度。结果:腔镜组患者年龄小于开放组,手术时间、拔除引流管时间均长于开放组,术后总引流量、手术费用、总费用均多于开放组,切口美容满意度高于开放组(P<0.05);两组性别、病理肿瘤最大径、肿瘤数量、肿瘤侧别、是否合并桥本氏甲状腺炎、术中出血量、淋巴结清扫数量、术后第1天疼痛评分、术后住院时间及术后并发症发生率差异均无统计学意义(P>0.05)。结论:对美容效果要求较高的年轻患者更倾向于行经胸乳入路腔镜甲状腺微小乳头状癌切除术。经胸乳入路腔镜甲状腺微小乳头状癌切除术在经济条件允许又有美容需求的情况下可作为甲状腺微小乳头状癌的首选治疗方式。
Objective:To investigate clinical efficacy,safety and health economics between endoscopic thyroidectomy via breast approach and conventional open thyroid surgery for papillary thyroid microcarcinoma.Methods:Retrospective analysis was performed on the clinical data of 44 cases of papillary thyroid microcarcinoma admitted to the same operation group from Sep.2018 to Aug.2020.Among them,21 cases(endoscopic group)underwent endoscopic thyroidectomy via breast approach,and 23 cases(open group)underwent conventional open thyroid surgery.Analysis and comparison was made between the two groups on the gender,age,maximum pathological diameter of tumor,the number of tumors,tumor side,whether Hashimoto's thyroiditis was combined,operation duration,intraoperative blood loss,the number of lymph nodes dissection,total drainage volume,drainage tube removal time,postoperative hospital stay,operation cost,total cost and the occurrence of postoperative complications.Visual analogue scale was used to evaluate the pain on the first day after surgery.A questionnaire was used to evaluate patients'aesthetic satisfaction with the incision 3 months after surgery.Results:Compared with the open group,the age of the endoscopic group was younger,the duration of surgery and drainage tube removal time were longer,the total postoperative drainage volume,operation cost and total cost were more,but the incision aesthetic satisfaction was higher(P<0.05);However,there were no statistically significant differences between the two groups in terms of gender,maximum pathological diameter of tumor,the number of tumors,tumor side,whether Hashimoto's thyroiditis was combined,the amount of intraoperative blood loss,the number of lymph nodes dissection,the pain score on the first day after surgery,the postoperative hospital stay and the occurrence of postoperative complications(P>0.05).Conclusions:Younger patients with higher cosmetic requirements are more likely to undergo endoscopic thyroidectomy via breast approach,which can be the first choice for patient
作者
李思佳
张亚坤
罗倩文
韩青青
王颖
郭飞跃
张静
LI Si-jia;ZHANG Ya-kun;LUO Qian-wen(Department of Glandular Surgery,Hebei General Hospital,Shijiazhuang 050051,China;Graduate School of North China University of Science and Technology)
出处
《腹腔镜外科杂志》
2021年第4期241-245,260,共6页
Journal of Laparoscopic Surgery
