中国普外基础与临床杂志

中国普外基础与临床杂志

颈前小切口入路与改良Miccoli腔镜辅助下甲状腺手术治疗甲状腺良性肿瘤的临床研究

查看全文

目的 比较颈前小切口入路甲状腺手术及改良Miccoli腔镜辅助下甲状腺手术治疗甲状腺良性肿瘤的疗效。
方法 回顾性分析笔者所在医院2010年1月至2012年1月期间收治的80例甲状腺良性肿瘤患者的临床资料,按手术方式将其分为颈前小切口组(n=40)和改良Miccoli组(n=40),比较2组患者的手术时间、术后颈部引流量、美容满意度、住院时间、住院费用及并发症发生率。
结果 与改良Miccoli组比较,颈前小切口组患者的手术时间较长〔(95.5±20.3) min比(62.4±15.5) min,P<0.05〕, 而美容满意度评分〔(3.5±0.2)分比(4.3±0.1)分〕和住院费用〔(5 814.6±1 262.3)元比(9 846.7±1 080.5)元〕均较低(P<0.05); 2组患者的术后颈部引流量〔(28.6±5.5) mL比(22.2±4.5) mL〕和住院时间〔(4.5±1.5) d比(3.8±0.9) d〕 比较差异均无统计学意义(P>0.05)。颈前小切口组有3例患者术后出现声音嘶哑,均于术后1个月左右恢复; 改良Miccoli组有1例患者术后出现声音嘶哑,于术后3个月左右恢复。2组患者的喉返神经损伤发生率比较差异无统计学意义(P=0.608)。2组患者均无其他手术并发症发生。
结论 改良Miccoli腔镜辅助下甲状腺手术的颈部美容效果优于颈前小切口入路手术,但前者的住院费用高于后者,对美容有特殊要求或是从事特殊职业的患者可选择性使用改良Miccoli腔镜辅助下甲状腺手术。

Objective To compare the therapeutic efficacy between the mini-incision anterior cervical approach thyroidectomy and modified Miccoli endoscopy assisted thyroidectomy for thyroid benign tumor.
Methods Clinical data of 80 patients with thyroid benign tumor treated in The First Affiliated Hospital of General Hospital of PLA from Jan.2010 to Jan. 2012 were retrospectively analyzed,and the 80 patients were divided into mini-incision anterior cervical approach thyroidectomy group (n=40) and modified Miccoli endoscopy assisted thyroidectomy group (n=40) according to operative type. The operative time,drainage volume of neck,cosmetic satisfaction score,duration of hospitalization,expense of hospitalization,and rates of postoperative complication of 2 groups were compared and analyzed.
Results The operative time of mini-incision anterior cervical approach thyroidectomy group were significantly longer than that of
modified Miccoli endoscopy assisted thyroidectomy group〔(95.5±20.3)min vs. (62.4±15.5)min,P<0.05〕,but the
cosmetic satisfaction score〔(3.5±0.2) score vs. (4.3±0.1) score〕and expense of hospitalization〔(5 814.6±1 262.3)
yuan vs. (9 846.7±1 080.5) yuan〕were lower (P<0.05). There were no significant differences on the drainage volume
of neck after operation〔(28.6±5.5) mL vs. (22.2±4.5) mL〕and duration of hospitalization〔(4.5±1.5) d vs. (3.8±0.9) d〕between the 2 groups (P>0.05). There were 3 cases happened transient hoarseness in mini-incision anterior cervical approach thyroidectomy group (all recovered in 1 month after operation) and 1 case in modified Miccoli endoscopy assi-
sted thyroidectomy group (recovered in 3 months after operation),and there were no significant difference on incidence of recurrent laryngeal nerve injury (P=0.608). No other complications happened.
Conclusions Modified Miccoli endoscopy assisted thyroidectomy has better cosmetic benefit than mini-incision anterior cervical approach thyroidectomy, but more expensive. The patients who have specific cosmetic demand or engage in special profession can choose modified Miccoli endoscopy assisted thyroidectomy.

关键词: 甲状腺良性肿瘤; 甲状腺手术; 改良Miccoli腔镜辅助手术; 颈前小切口入路; 疗效

Key words: Thyroid benign tumor; Thyroidectomy; Modified Miccoli endoscopy assisted operation; Mini-incision anterior cervical approach; Efficacy

引用本文: 姚京,刘飞德,戎世捧,陈峰,朱瑛梅,姚胜. 颈前小切口入路与改良Miccoli腔镜辅助下甲状腺手术治疗甲状腺良性肿瘤的临床研究. 中国普外基础与临床杂志, 2013, 20(4): 418-422. doi: 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
1. Miccoli P, Berti P, Frustaci GL, et al. Video-assisted thyroidectomy:indications and results[J]. Langenbecks Arch Surg, 2006, 391(2):68-71.
2. 吕磊, 马少林, 伊其忠. 美容整形受术者心理评估与术后满意度的相关性研究[J]. 现代生物医学进展, 2008, 8(1):141-143.
3. 朱利锋, 林海平, 刘湘岳. 甲状腺手术引流方式探讨[J]. 临床军医杂志, 2006, 34(2):245-246.
4. Gagner M. Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism[J]. Br J Surg, 1996, 83(6):875.
5. Hüscher CS, Chiodini S, Napolitano C, et al. Endoscopic right thyroid lobectomy[J]. Surg Endosc, 1997, 11(8):877.
6. Miccoli P, Pinchera A, Cecchini G, et al. Minimally invasive, video-assisted parathyroid surgery for primary hyperparathyroidism[J]. J Endocrinol Invest, 1997, 20(7):429-430.
7. 高力. Miccoli内镜术式与甲状腺手术操作的微创化[J]. 中华外科杂志, 2006, 44(1):10-13.
8. Ikeda Y, Takami H, Tajima Gengo, et al. Direct mini-incision thyroidectomy[J]. Biomed Pharmacother, 2002, 56 Suppl 1:60s-63s.
9. 杨鹏, 牟一平, 朱玲华, 等. 内镜辅助下单个小切口甲状腺手术[J]. 中国内镜杂志, 2006, 12(7):758-760.
10. Lombardi CP, Raffaelli M, Princi P, et al. Minimally invasive video-assisted functional lateral neck dissection for metastatic papillary thyroid carcinoma[J]. Am J Surg, 2007, 193(1):114-118.
11. Miccoli P, Berti P, Raffaelli M, et al. Minimally invasive video-assisted thyroidectomy[J]. Am J Surg, 2001, 181(6):567-570.
12. Miccoli P, Elisei R, Materazzi G, et al. Minimally invasive video-assisted thyroidectomy for papillary carcinoma:a prospective study of its completeness[J]. Surgery, 2002, 132(6):1070-1073.
13. Miccoli P, Materazzi G, Berti P. Minimally invasive video-assisted lateral lymphadenectomy:a proposal[J]. Surg Endosc, 2008, 22(4):1131-1134.
14. Shimizu K, Tanaka S. Asian perspective on endoscopic thyroidectomy—a review of 193 cases[J]. Asian J Surg, 2003, 26(2):92-100.
15. 李德祥, 王希, 陈超, 等. 非窥镜微创低位小切口入路行甲状腺手术2 336例分析[J]. 临床和实验医学杂志, 2008, 7(7):148-149.
16. Roye GD, Monchik J, Amaral JF. Endoscopic adrenalectomy using ultrasonic cutting and coagulating[J]. Surg Technol Int, 2000, Ⅸ:129-138.
17. Takao S, Shinchi H, Maemura K, et al. Ultrasonically activated scalpel is an effective tool for cutting the pancreas in biliary-pancreatic surgery:experimental and clinical studies[J]. J Hepatobiliary Pancreat Surg, 2000, 7(1):58-62.
18. Kanehira E, Omura K, Kinoshita T, et al. How secure are the arteries occluded by a newly developed ultrasonically activated device?[J]. Surg Endosc, 1999, 13(4):340-342.
19. Miccoli P, Berti P, Dionigi G, et al. Randomized controlled trial of harmonic scalpel use during thyroidectomy[J]. Arch Otolaryngol Head Neck Surg, 2006, 132(10):1069-1073.
20. Siperstein AE, Berber E, Morkoyun E. The use of the harmonic scalpel vs. conventional knot tying for vessel ligation in thyroid surgery[J]. Arch Surg, 2002, 137(2):137-142.
21. Cordón C, Fajardo R, Ramírez J, et al. A randomized, prospective, parallel group study comparing the Harmonic Scalpel to electrocautery in thyroidectomy[J]. Surgery, 2005, 137(3):337-341.
22. Shemen L. Thyroidectomy using the harmonic scalpel:analysis of 105 consecutive cases[J]. Otolaryngol Head Neck Surg, 2002, 127(4):284-288.
23. Voutilainen PE, Haglund CH. Ultrasonically activated shears inthyroidectomies:a randomized trial[J]. Ann Surg, 2000, 231 (3):322-328.
24. 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[J]. 中国普外基础与临床杂志, 2010, 17(3):240-242.
25. Owaki T, Nakano S, Arimura K, et al. The ultrasonic coagulating and cutting system injures nerve function[J]. Endoscopy, 2002, 34(7):575-579.