腔镜辅助下与全腔镜甲状腺切除术的对比分析.docVIP

　　腔镜辅助下与全腔镜甲状腺切除术的对比分析 作者：王瑜　林晨　张再重　王烈　邹忠东 【摘要】 目的：对比腔镜辅助下(video-assisted thyroidectomy， VAT)与全腔镜甲状腺切除术(total endoscopic thyroidectomy， TET)的手术特点。方法：回顾性分析行胸骨切迹上径路颈部小切口VAT 65例和胸前壁径路TET 59例的临床资料。比较2种术式的手术时间、术中失血量、疼痛评分、术后住院时间、并发症和复发率。结果：120例手术成功，4例(VAT和TET组各2例)中转开放手术。VAT组和TET组手术时间分别为(44.15±12.11)min和(115.42±28.36)min，术中失血量分别为(9.54±4.21)mL和(20.68±7.40)mL，疼痛评分分别为3.62±0.93和5.37±0.90，术后住院时间分别为(3.31±0.86)d和(5.31±0.79)d，术后并发症发生率分别为1.54%和15.25%，2组差异均具有统计学意义(Plt;0.01或Plt;0.05)。2组术后均无继发出血、永久性声嘶、低血钙等并发症。随访3～37个月，平均17.17个月，复发3例，其中VAT组1例，TET组2例，两组复发率差异无统计学意义(P gt;0.05)。结论：2种腔镜手术 治疗 甲状腺良性肿瘤均安全有效。与TET相比，VAT技术难度较低，并发症较少，并具有创伤小、恢复快、术后疼痛轻等优点，是可选择的手术方式之一。 【关键词】 腔镜·甲状腺疾病·甲状腺切除术 　　【ABSTRACT】 Objective：To pare the total endoscopic thyroidectomy and the video-assisted thyroidectomy, and explore the safety and invasion of the tethods. Methods： 124 cases of benign thyroid diseases November 2005 to September 2008, including 59 cases of total endoscopic thyroidectomy (TET Group) and 65 cases of video-assisted thyroidectomy (VAT Group). The operation time, hemorrhage volume, Visual Analogue Scale (VAS) scores for pain severity, postoperative hospital stay, postoperative plication, recurrent rate and reversed operation to open surgery ean time of operation in in VAT and 115.42±28.36 min in TET, Plt;0.01). The mean volume of hemorrhage during operation L in VAT group and 20.68±7.40 mL in TET group (Plt;0.01). The VAS scores for pain severity, the mean length of postoperative hospital stay and the rate of postoperative plication orrhage, permanent hoarseness or hypocalcemia edian folloonths (range from 3 to 37 months)，there y and the video-assisted thyroidectomy offer a safe therapeutic approach alloy，the video-assisted thyroidectomy has the advantages of less operation time, minimal invasion, earlier recovery, and less pain. The video-assisted thyroidectomy is another ideal option for benign thyroid diseases. 　　【KEY y 　　传统甲状腺开放手术在颈部留有较明显的瘢痕，给患者带来较大的身心创伤。1997年Hüscher等[1]报道了首例腔镜甲状腺切除术，标志着腔镜