中国普外基础与临床杂志

中国普外基础与临床杂志

腔镜甲状腺手术与传统甲状腺手术后的并发症比较

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目的 探讨腔镜甲状腺手术的并发症发生情况并分析其原因,以减少腔镜甲状腺手术并发症的发生。 方法 回顾性分析 2008 年 9 月至 2017 年 3 月期间笔者所在医院收治的 1 112 例甲状腺疾病患者的临床资料,根据其手术方式不同分为全腔镜甲状腺切除组(简称腔镜组)和传统甲状腺切除组(简称传统组),观察 2 组患者术后喉返神经损伤、甲状旁腺功能减退、术后出血、气管和食管损伤、切口愈合不良、皮下积液和皮肤瘀斑、颈部不适及 CO2 相关并发症的发生情况。 结果 ① 腔镜组 582 例,传统组 530 例,2 组患者的年龄、性别、肿块最大直径、疾病类型、手术方式、手术时间、术中出血量等基线资料比较差异均无统计学意义(P>0.05),具有可比性。② 2 组患者的手术均成功完成,腔镜组无中转为开放手术患者。2 组患者的喉返神经损伤率、甲状旁腺功能减退率、术后出血率、气管和食管损伤率比较差异均无统计学意义(P>0.05),腔镜组的切口愈合不良和颈部不适发生率明显低于传统组(P<0.05),皮下积液和皮肤瘀斑发生率明显高于传统组(P<0.05);腔镜组有 32 例发生了 CO2 相关并发症。 结论 腔镜甲状腺手术是安全的,其并发症可通过改善操作技术得以减少其发生。

Objective To explore complications of endoscopic thyroidectomy and conventional thyroidectomy and to analyze causes of them in order to reducing complications of endoscopic thyroidectomy. Methods A total of 1 112 patients with thyroid diseases from September 2008 to March 2017 in the Shanghai Tongren Hospital were collected, then were designed to endoscopic thyroidectomy group and conventional thyroidectomy group. The recurrent laryngeal nerve injury, hypoparathyroidism, postoperative bleeding, tracheoesophageal injury, poor healing of surgical wound, skin ecchymosis and subcutaneous effusion, neck discomfort, and CO2 related complications were observed. Results ① There were 582 cases in the endoscopic thyroidectomy group and 530 cases in the conventional thyroidectomy group, the baselines such as the gender, age, most diameter of tumor, diseases type, operative mode, operative time, and intraoperative bleeding had no significant differences between the endoscopic thyroidectomy group and the conventional thyroidectomy group (P>0.05). ② All the operations were performed successfully, none of patients was converted to the open operation. The rates of the recurrent laryngeal nerve injury, hypoparathyroidism, postoperative bleeding, and tracheoesophageal injury had no significant differences in these two groups (P>0.05). The rates of the poor healing of surgical wound and neck discomfort were significantly lower and the rate of the skin ecchymosis and subcutaneous effusion was significantly higher in the endoscopic thyroidectomy group as compared with the conventional thyroidectomy group (P<0.05). There were 32 cases of CO2 related complications in the endoscopic thyroidectomy group. Conclusion Results of this study show that endoscopic thyroidectomy is safe for thyroid diseases, it’s complications could be reduced by improving operation technique.

关键词: 甲状腺切除术; 内镜; 并发症

Key words: thyroidectomy; endoscopic; complications

引用本文: 刘溦薇, 周鸣, 赵吉, 孙鹏. 腔镜甲状腺手术与传统甲状腺手术后的并发症比较. 中国普外基础与临床杂志, 2018, 25(3): 323-327. doi: 10.7507/1007-9424.201708032 复制

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1. 仇明, 丁尔迅, 江道振, 等. 颈部无瘢痕内镜甲状腺切除 1 例. 中华普通外科杂志, 2002, 17(2): 127.
2. 王存川, 苏超. 内镜甲状腺切除术的现状及前景. 临床外科杂志, 2005, 13(10): 605-606.
3. Puntambekar S, Sharma V, Kumar S, et al. Management of large size MNGs and STNs using 3D endoscopic technique: a review of 10 cases. Indian J Surg, 2016, 78(2): 117-120.
4. 由田, 胡友主. 完全乳晕入路腔镜甲状腺手术后并发症的研究进展. 腹腔镜外科杂志, 2017, 22(4): 308-312.
5. 苏磊, 桑剑锋, 姚永忠, 等. 经胸乳入路腔镜甲状腺切除的手术技巧. 中国普外基础与临床杂志, 2013, 20(5): 512-516.
6. Kandil EH, Noureldine SI, Yao L, et al. Robotic transaxillary thyroidectomy: an examination of the first one hundred cases. J Am Coll Surg, 2012, 214(4): 558-566.
7. Park KN, Cho SH, Lee SW. Nationwide multicenter survey for current status of endoscopic thyroidectomy in Korea. Clin Exp Otorhinolaryngol, 2015, 8(2): 149-154.
8. Choi JY, Lee KE, Chung KW, et al. Endoscopic thyroidectomy via bilateral axillo-breast approach (BABA): review of 512 cases in a single institute. Surg Endosc, 2012, 26(4): 948-955.
9. 关强, 王贵民, 王宏升. 胸骨前径路与改良 Miccoli 腔镜甲状腺手术临床研究. 中国普外基础与临床杂志, 2010, 17(3): 240-242.
10. Yan H, Wang Y, Wang P, et al. " Scarless” (in the neck) endoscopic thyroidectomy (SET) with ipsilateral levels Ⅱ, Ⅲ, and Ⅳ dissection via breast approach for papillary thyroid carcinoma: a preliminary report. Surg Endosc, 2015, 29(8): 2158-2163.
11. Dionigi G, Wu CW, Kim HY, et al. Safety of energy based devices for hemostasis in thyroid surgery. Gland Surg, 2016, 5(5): 490-494.
12. He QQ, Zhu J, Zhuang DY, et al. Comparative study between robotic total thyroidectomy with central lymph node dissection via bilateral axillo-breast approach and conventional open procedure for papillary thyroid microcarcinoma. Chin Med J (Engl), 2016, 129(18): 2160-2166.
13. Zhou J, Wu Z, Wang Y, et al. Endoscopic thyroidectomy for bilateral thyroid diseases: safety and effectiveness. J Craniofac Surg, 2012, 23(2): 565-570.
14. Liao HJ, Dong C, Kong FJ, et al. The CUSUM analysis of the learning curve for endoscopic thyroidectomy by the breast approach. Surg Innov, 2014, 21(2): 221-228.
15. Tori M. Hybrid-type endoscopic thyroidectomy (HET: Tori’s method) for differentiated thyroid carcinoma including invasion to the trachea. Surg Endosc, 2014, 28(3): 902-909.
16. 孙丕东, 沈永宽. 影像切口愈合的因素与防治措施. 中国医学创新, 2008, 5(35): 40-41.
17. Wang C, Feng Z, Li J, et al. Endoscopic thyroidectomy via areola approach: summary of 1 250 cases in a single institution.Surg Endosc, 2015, 29(1): 192-201.
18. Jin X, Lu B, Cai X, et al. Total endoscopic thyroidectomy via bilateral breast and ipsilateral axillary approach: a clinical feasibility study. J Craniofac Surg, 2014, 25(3): 738-741.
19. Park KN, Mok JO, Chung CH, et al. Does postthyroidectomy syndrome really exist following thyroidectomy? Prospective comparative analysis of open vs. endoscopic thyroidectomy. Clin Exp Otorhinolaryngol, 2015, 8(1): 76-80.
20. Kang JB, Kim EY, Park YL, et al. A comparison of postoperative pain after conventional open thyroidectomy and single-incision, gasless, endoscopic transaxillary thyroidectomy: a single institute prospective study. Ann Surg Treat Res, 2017, 92(1): 9-14.
21. Wang YC, Zhu JQ, Liu K, et al. Surgical outcomes comparison between endoscopic and conventional open thyroidectomy for benign thyroid nodules. J Craniofac Surg, 2015, 26(8): e714-e718.
22. Bhargav PR, Amar V. Operative technique of endoscopic thyroidectomy: a narration of general principles.Indian J Surg, 2013, 75(3): 216-219.
23. Youben F, Bo W, Chunlin Z, et al. Trans-areola single-site endoscopic thyroidectomy: pilot study of 35 cases. Surg Endosc, 2012, 26(4): 939-947.
24. Duke WS, White JR, Waller JL, et al. Endoscopic thyroidectomy is safe in patients with a high body mass index. Thyroid, 2014, 24(7): 1146-1150.
25. Zhang W, Dang C, Shan C, et al. Use of a mini-instrument in endoscopic thyroidectomy via a breast approach to improve cosmetic outcomes. Biosci Trends, 2014, 8(5): 280-285.
26. Henry BM, Graves MJ, Vikse J, et al. The current state of intermittent intraoperative neural monitoring for prevention of recurrent laryngeal nerve injury during thyroidectomy: a PRISMA-compliant systematic review of overlapping meta-analyses. Langenbecks Arch Surg, 2017, 402(4): 663-673.
27. Chang EHE, Kim HY, Koh YW, et al. Overview of robotic thyroidectomy. Gland Surg, 2017, 6(3): 218-228.