李吉等

[摘要] 目的 比较分析腔镜辅助下小切口甲状腺手术与传统开放性甲状腺手术治疗甲状腺良性肿瘤的疗效及安全性。 方法 选择2013年1月～2014年1月期间在浙江省宁波市北仑区人民医院住院并接受手术治疗的 68 例甲状腺良性肿瘤患者分为腔镜辅助组（n=34例）与对照组（n=34例），其中腔镜辅助组采用腔镜辅助下小切口甲状腺切除术，对照组采用开放性甲状腺切除术。观察并比较两组患者的手术时间、术中出血量、术后引流量、拔管时间、切口长度、住院时间及术后并发症发生情况。 结果 腔镜辅助组患者的手术时间、术后出血量、术后引流量、拔管时间、切口长度、住院时间及术后并发症发生率[（53.75±12.76）min、（12.46±3.27）mL、（28.89±6.47）mL、（2.13±0.57）d、（3.17±0.84）cm、（3.45±0.73）d、5.9%]均明显少于对照组[（85.46±15.46）min、（14.68±4.18）mL、（32.18±7.03）mL、（3.42±0.64）d、（5.42±1.13）cm、（4.88±0.95）d、23.5%] （P<0.01或P<0.05）。术后随访4～16个月，平均（9.7±1.8）个月，腔镜辅助组复发1例，对照组复发3例。两组术后复发率比较差异无统计学意义（χ2=0.27，P>0.05）。结论 腔镜辅助下小切口甲状腺手术治疗甲状腺良性肿瘤较传统开放性手术治疗具有手术时间短、术中出血少、术后恢复快、美容效果好、术后并发症少等优点。

[关键词] 甲状腺良性肿瘤；甲状腺手术；腔镜辅助下小切口；传统开放性

[中图分类号] R736.1 [文献标识码] B [文章编号] 1673-9701（2014）29-0137-03

Curative effect and security of thyroidectomy with minimal incision in neck to treat thyroid benign neoplasm under laparoscopy

LI Ji1 LIU Weihuai1 WU Yijun2

1.General Surgery Department， Beilun District Peoples Hospital of Ningbo City， Ningbo 315800， China； 2.Thyroid Surgery Department， the First Affiliated Hospital of Zhejiang University College of Medicine， Hangzhou 310003， China

[Abstract] Objective To compare and analyze the curative effect and security of thyroidectomy with minimal incision in neck under laparoscopy and traditional open thyroid operation to treat thyroid benign neoplasm. Methods A total of 68 cases of patients with thyroid benign neoplasm were given the operation in Beilun District Peoples Hospital during the period from January 2013 to January 2014， and they were divided into laparoscopy assisted group （n=34） and control group （n=34）. The patients in laparoscopy assisted group were given minimal incision in neck under laparoscopy， while the patients in control group were given open thyroid operation. The operation time， intraoperative amount of blood， postoperative amount of drainage， time of extubation， incision length， length of stay （LOS） and operative occurrence of complication were observed and compared. Results The operation time， intraoperative amount of blood， postoperative amount of drainage， time of extubation， incision length， length of stay （LOS） and operative occurrence of complication of patients in laparoscopy assisted group [（53.75±12.76）min， （12.46±3.27）mL， （28.89±6.47）mL， （2.13±0.57）d， （3.17±0.84）cm， （3.45±0.73）d， 5.9%]were obviously shorter or less or lower than those in control group [（85.46±15.46）min， （14.68±4.18）mL， （32.18±7.03）mL， （3.42±0.64）d， （5.42±1.13）cm， （4.88±0.95）d， 23.5%]（P<0.01 or P<0.05）. After a median follow-up of （9.7±1.8） months （range from 4 to 16 months）， 1 case in laparoscopy assisted group and 3 cases in control group were recurred. The recurrent rate in two groups had no difference（χ2=0.27， P>0.05）. Conclusion Compared with traditional open thyroid operation， thyroidectomy with minimal incision in neck under laparoscopy to treat thyroid benign neoplasm have the following advantages， shorter operation time， less intraoperative amount of blood， quicker postoperative recovery， more favorable cosmetic effect， less postoperative complication and so on.endprint

[Key words] Thyroid benign neoplasm； Thyroid operation； Minimal incision in neck under laparoscopy； Traditional open

甲状腺良性肿瘤是甲状腺科最常见的疾病之一，包括甲状腺腺瘤、甲状腺囊肿、结节等，甲状腺良性肿瘤极少数可能出现恶变，约占所有患者的10%左右[1]。手术是治疗甲状腺良性肿瘤的首选治疗方法，传统的手术方法颈部手术切口大，术后留有瘢痕，影响患者的美观，患者身心创伤较大。近年来腔镜辅助小切口甲状腺手术是将腔镜技术应用于甲状腺手术，可减小颈部瘢痕，已逐渐在临床推广应用[2，3]。……