Department of Surgical Science, Unit of General Surgery and Organ Transplantation, University Hospital of Parma, Via Gramsci 14, 43100, Parma, Italy.
Langenbecks Arch Surg. 2010 Apr;395(4):323-6. doi: 10.1007/s00423-009-0589-2. Epub 2010 Feb 16.
The evolution of video-assisted or laparoscopic surgical techniques in the last several years has changed the surgical treatment approach to many diseases, also in endocrine surgery.
From July 2005 to March 2009, we treated 211 patients with minimally invasive video-assisted thyroidectomy (MIVAT). The procedure was performed in accordance with Miccoli's technique using an Ultracision CS 14 (Ethicon Endosurgery) and/or Single Use Automatic Clip Applier S-90 (Autosuture). In all cases, we recorded the incidence of postoperative hypocalcaemia as a serum calcium value lower than 8 mg/dl with or without hypocalcaemic symptoms, postoperative haemorrhage or nerve palsy, mean operative time. All patients were also assessed for postoperative pain and given a visual analogue score from 0 to 10 at 1 and 24 h after surgery. We matched these results with a group of 587 patients treated during the same period with traditional thyroidectomy.
The female/male ratio was 4:1; the mean age of the patients was 50.6 years. In the MIVAT group, the mean time of surgical procedure decreased by 52.4 min. We observed 16 hypocalcaemic cases with clinical symptoms (7.58%) (six of these cases were published in a previous article and were among the first 100 cases treated) and 59 cases of serologic hypocalcaemia (27.9%) (serum calcium lower than 8 mg/dl); the mean value of calcium concentration was 7.5 +/- 0.27 mg/dl. We observed six cases of monolateral nerve palsy, and after 6 months, a definitive palsy in two cases (0.9%); these two cases were in the first 25 cases treated. Comparisons with traditional thyroidectomy group showed statistically significant differences in postoperative serologic hypocalcaemia (p < 0.001), no difference in mean calcium value (p = 0.41) and no statistical difference in the incidences of nerve palsy and haemorrhage.
Patients treated with MIVAT showed an improvement in incidence of postoperative hypocalcaemia, postoperative pain, postoperative stay, psychophysical recovery and cosmetic result.
近年来，视频辅助或腹腔镜手术技术的发展改变了许多疾病的外科治疗方法，包括内分泌手术。
自 2005 年 7 月至 2009 年 3 月，我们对 211 例患者进行了微创视频辅助甲状腺切除术（MIVAT）。该手术按照 Miccoli 技术进行，使用 Ultracision CS 14（Ethicon Endosurgery）和/或单用途自动夹取器 S-90（Autosuture）。在所有病例中，我们记录了术后低钙血症的发生率，即血清钙值低于 8mg/dl 伴有或不伴有低钙血症症状、术后出血或神经麻痹、平均手术时间。所有患者还评估了术后疼痛，并在术后 1 小时和 24 小时分别给予 0 至 10 的视觉模拟评分。我们将这些结果与同期接受传统甲状腺切除术的 587 例患者的结果进行了比较。
男女比例为 4:1；患者的平均年龄为 50.6 岁。在 MIVAT 组，手术时间平均缩短了 52.4 分钟。我们观察到 16 例有临床症状的低钙血症病例（7.58%）（其中 6 例在之前的一篇文章中报道，是前 100 例治疗中的病例）和 59 例血清钙降低的低钙血症病例（27.9%）（血清钙值低于 8mg/dl）；血清钙浓度的平均值为 7.5+/-0.27mg/dl。我们观察到 6 例单侧神经麻痹，6 个月后 2 例出现永久性麻痹（0.9%）；这两例发生在前 25 例治疗中。与传统甲状腺切除术组相比，术后血清钙降低有统计学差异（p<0.001），但平均钙值无差异（p=0.41），神经麻痹和出血的发生率也无统计学差异。
接受 MIVAT 治疗的患者术后低钙血症、术后疼痛、术后住院时间、心理生理恢复和美容效果均有改善。
