經(jīng)胸乳入路腔鏡與頸部入路常規(guī)手術(shù)對(duì)甲狀腺良性腫瘤效果

宋聰睿 王勇 高陽(yáng)

摘要：目的 ?觀察經(jīng)胸乳入路腔鏡與頸部入路常規(guī)手術(shù)治療甲狀腺良性腫瘤的效果。方法 ?選取2016年9月～2019年9月我院接診的100例甲狀腺良性腫瘤患者為研究對(duì)象，采用隨機(jī)數(shù)字表法分為常規(guī)組和觀察組，各50例。常規(guī)采用頸部入路常規(guī)手術(shù)治療，觀察組采用經(jīng)胸乳入路腔鏡治療，比較兩組腫瘤切除率、手術(shù)指標(biāo)（手術(shù)時(shí)間、術(shù)中出血量、術(shù)后疼痛度、術(shù)后切口引流量）、甲狀腺功能指標(biāo)[促甲狀腺激素（TSH）、甲狀腺素（T4）、游離甲狀腺素（FT4）、游離三碘甲狀腺原氨酸（FT3）]、甲狀旁腺功能指標(biāo)[甲狀旁腺激素（PTH）、血鈣水平、并發(fā)癥發(fā)生率以及美觀滿意度評(píng)分。結(jié)果 ?觀察組腫瘤切除率為98.00%，與常規(guī)組的96.00%比較，差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）;觀察組手術(shù)時(shí)間長(zhǎng)于常規(guī)組，術(shù)中出血量、術(shù)后疼痛度、術(shù)后切口引流量均小于常規(guī)組（P<0.05）;術(shù)后兩組TSH、T4、FT3水平均低于術(shù)前，F(xiàn)T4均高于術(shù)前（P<0.05），但觀察組TSH、T4、FT3、FT4與常規(guī)組比較，差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）;兩組術(shù)后PTH水平均高于術(shù)前、血鈣水平均低于術(shù)前（P<0.05），但觀察組與常規(guī)組比較（P>0.05）;觀察組并發(fā)癥發(fā)生率為2.00%，低于常規(guī)組的8.00%（P<0.05）;觀察組美觀滿意度評(píng)分高于常規(guī)組（P<0.05）。結(jié)論 ?經(jīng)胸乳入路腔鏡與頸部入路常規(guī)手術(shù)治療甲狀腺良性腫瘤均可獲得較理想的效果，對(duì)甲狀腺和甲狀旁腺功能影響基本相似。但是前者術(shù)中出血量少，術(shù)后疼痛度輕、引流量少，對(duì)患者創(chuàng)傷小，術(shù)后并發(fā)癥少，利于患者康復(fù)，且瘢痕小，可獲得較高的美觀滿意度。

關(guān)鍵詞：經(jīng)胸乳入路腔鏡;頸部入路;甲狀腺良性腫瘤;并發(fā)癥

中圖分類(lèi)號(hào)：R736.1 ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? 文獻(xiàn)標(biāo)識(shí)碼：A ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? DOI：10.3969/j.issn.1006-1959.2020.17.031

文章編號(hào)：1006-1959（2020）17-0106-03

Abstract：Objective ?To observe the effect of transthoracic approach and conventional cervical approach in the treatment of benign thyroid tumors. Methods ?A total of 100 patients with benign thyroid tumors admitted to our hospital from September 2016 to September 2019 were selected as the research objects. They were divided into the routine group and the observation group by random number table method， with 50 cases in each group. Routine neck approach was used for conventional surgical treatment， and the observation group was treated with transthoracic approach endoscopic treatment. The tumor resection rate and surgical indicators （operating time， intraoperative blood loss， postoperative pain， postoperative incision drainage volume were compared between the two groups）， thyroid function indexes [thyroid stimulating hormone （TSH）， thyroxine （T4）， free thyroxine （FT4）， free triiodothyronine （FT3）]， parathyroid function indexes [parathyroid hormone （PTH） ）， blood calcium level， complication rate and aesthetic satisfaction score.Results ?The tumor resection rate in the observation group was 98.00%， compared with 96.00% in the conventional group， the difference was not statistically significant （P>0.05）; the operation time in the observation group was longer than that in the conventional group， intraoperative blood loss， postoperative pain， postoperative incision induction the flow rate was less than that of the conventional group（P<0.05）; the levels of TSH， T4， and FT3 in the two groups after surgery were lower than those before surgery， and FT4 was higher than that before surgery（P<0.05），but the observation group TSH， T4， FT3， FT4 compared with the conventional group， the difference was not statistically significant （P>0.05）;The postoperative PTH levels of the two groups were higher than preoperatively， and the blood calcium levels were lower than preoperatively（P<0.05）， but the observation group was compared with the routine group （P>0.05）; complications occurred in the observation group rate was 2.00%， which was lower than 8.00% of the conventional group（P<0.05）; the aesthetic satisfaction score of the observation group was higher than that of the conventional group（P<0.05）.Conclusion ?Both transthoracic approach and conventional cervical approach for the treatment of benign thyroid tumors could achieve satisfactory results， and the effects on thyroid and parathyroid functions were basically similar. However， the former had less intraoperative blood loss， mild postoperative pain， less drainage， less trauma to the patient， less postoperative complications， conducive to patient recovery， and small scars， which could achieve high aesthetic satisfaction.

Key words：Transthoracic approach endoscopy;Neck approach;Benign thyroid tumor;Complications

甲狀腺（thyroid gland）良性腫瘤是臨床常見(jiàn)疾病，手術(shù)是臨床常規(guī)治療手段[1]。頸部入路是常規(guī)治療甲狀腺良性腫瘤的主要術(shù)式，但該術(shù)式手術(shù)切口長(zhǎng)，患者創(chuàng)傷大，術(shù)后疼痛度高，恢復(fù)慢，且術(shù)后手術(shù)瘢痕明顯，頸部美觀受到嚴(yán)重影響[2]。隨著臨床微創(chuàng)理念的不斷發(fā)展，腹腔鏡以創(chuàng)傷小、出血量少、恢復(fù)快的優(yōu)點(diǎn)廣泛應(yīng)用于臨床多種疾病治療[3]。目前，經(jīng)胸乳入路腔鏡術(shù)式治療甲狀腺良性腫瘤已在臨床應(yīng)用，且取得一定效果，但是經(jīng)胸乳入路腔鏡與頸部入路常規(guī)術(shù)式治療甲狀腺良性腫瘤的優(yōu)劣勢(shì)尚存在爭(zhēng)議，還需要臨床進(jìn)行深入的研究證實(shí)[4]。本研……