Sywak Mark S, Yeh Michael W, McMullen Todd, Stalberg Peter, Low Hubert, Alvarado Raul, Sidhu Stan B, Delbridge Leigh W
University of Sydney Endocrine Surgical Unit, Royal North Shore Hospital, St Leonards, Australia.
Surgery. 2008 Dec;144(6):1016-21; discussion 1021-2. doi: 10.1016/j.surg.2008.07.024.
The role of minimally invasive thyroid surgery (MITS) is currently in evolution. The aim of this study is to compare the outcomes of MITS using the direct approach through a lateral incision with conventional hemithyroidectomy (CHT) for the management of atypical thyroid nodules.
A prospective, single-blinded, randomized controlled trial involving patients presenting with atypical thyroid nodules of 3-cm diameter or less was performed. Patients were randomized to MITS through a lateral 2.5-cm incision or CHT through a traditional 5- to 6-cm cervicotomy. Pain was measured using a 7-point visual analog scale on the 1st and 10th postoperative days. Serum C-reactive protein was measured on postoperative days 1 and 10. Satisfaction with cosmetic outcome was measured at 3 months.
One-hundred patients were randomized to undergo MITS or CHT. The 2 groups were equivalent in terms of age and thyroid nodule size. Mean operative times were longer for the MITS group (56 vs 46 min, P < .001). Mean pain scores were less in the MITS group on the 1st postoperative day (2.67 vs 3.43, P = .032). Pain scores at 10 days were equivalent (1.5 vs 1.8, P = .36). Serum C-reactive protein levels were equivalent postoperatively. At 3 months, patients undergoing MITS reported a greater mean cosmetic satisfaction score (6.3 vs 5.0, P = .002). Incision lengths measured at 3 months were 2.6 cm for MITS and 5.4 cm for CHT group, P < .001.
In the management of small, atypical thyroid nodules, MITS through a direct lateral approach results in less early postoperative pain and superior cosmetic results when compared with conventional thyroidectomy.
微创甲状腺手术（MITS）的作用目前正在不断发展。本研究的目的是比较通过外侧切口直接入路的MITS与传统半甲状腺切除术（CHT）治疗非典型甲状腺结节的效果。
进行了一项前瞻性、单盲、随机对照试验，纳入直径3厘米及以下的非典型甲状腺结节患者。患者被随机分为通过2.5厘米外侧切口进行MITS组或通过传统5至6厘米颈部切开术进行CHT组。在术后第1天和第10天使用7分视觉模拟量表测量疼痛程度。在术后第1天和第10天测量血清C反应蛋白。在3个月时测量对美容效果的满意度。
100名患者被随机分配接受MITS或CHT。两组在年龄和甲状腺结节大小方面相当。MITS组的平均手术时间较长（56分钟对46分钟，P <.001）。MITS组术后第1天的平均疼痛评分较低（2.67对3.43，P =.032）。第10天的疼痛评分相当（1.5对1.8，P =.36）。术后血清C反应蛋白水平相当。在3个月时，接受MITS的患者报告的平均美容满意度评分更高（6.3对5.0，P =.002）。3个月时测量的切口长度，MITS组为2.6厘米，CHT组为5.4厘米，P <.001。
在治疗小的非典型甲状腺结节时，与传统甲状腺切除术相比，通过直接外侧入路的MITS术后早期疼痛较轻，美容效果更佳。
