Cai Qian, Huang Xiao-ming, Sun Wei, Zheng Yi-qing, Liang Fa-ya, Han Ping, Jiang Xiao-yu
Department of Otolaryngology-Head and Neck, Affiliated Second Hospital, Sun Yat-sen University, Guang zhou, China.
Surg Laparosc Endosc Percutan Tech. 2012 Jun;22(3):255-9. doi: 10.1097/SLE.0b013e3182508380.
Thyroidectomy can be performed in a variety of ways, and gasless video-assisted approaches have recently become more popular. We performed a study of thyroidectomy on 77 patients with bilateral thyroid lesions carried out using a gasless video-assisted unilateral anterior chest wall approach. Seventy-seven patients underwent bilateral thyroidectomy by the gasless video-assisted unilateral anterior chest wall approach, whereas 64 patients underwent conventional surgery during the same time frame and were considered to be the control group. The eligibility criteria for thyroid surgery by gasless video-assisted unilateral anterior chest wall approach were: no previous neck surgical history, no radiotherapy history, a diagnosis of benign thyroid tumor according to preoperative computed tomographic scan, no inflammation-related diseases or thyroid hyperfunction, no lymphadenectasis, and bilateral tumors ≤ 4 cm in diameter (1 side ≤ 2 cm, located in the lower part of the thyroid and near the surface of the thyroid). The 2 groups were compared by surgical style, complications, operative time, cosmetic result, and postoperative pain. The 2 groups were matched in terms of age and sex; the scoring for operative procedure (P=0.443), postoperative drainage (P=0.686), and postoperative pain (P=0.294) were not significantly different. The gasless video-assisted group had less bleeding during surgery than the conventional group and had better cosmetic results (P<0.001), but also had longer surgical durations (P=0.003) and higher costs of hospitalization (P<0.001). Neither group had any permanent recurrent laryngeal nerve paralysis or hypocalcemia, nor were there recurrences duration followed up for 21 ± 10 months. The gasless video-assisted group had 1 case of ecchymoma and 1 case of temporary recurrent laryngeal nerve paralysis, but both recovered within a month. The complication rates in the 2 groups were not significantly different (χ=1.423, P=0.292). The gasless video-assisted thyroidectomy by the unilateral anterior chest wall approach is a safe and feasible way to treat patients with benign bilateral thyroid lesion with good cosmetic results. The gasless video-assisted thyroidectomy is a valid surgical option for selected patients and that its application will grow in the future.
甲状腺切除术可以通过多种方式进行，无气视频辅助手术方法近年来越来越受欢迎。我们对77例双侧甲状腺病变患者采用无气视频辅助单侧前胸壁入路进行了甲状腺切除术研究。77例患者采用无气视频辅助单侧前胸壁入路行双侧甲状腺切除术，而64例患者在同一时间段接受传统手术，被视为对照组。无气视频辅助单侧前胸壁入路甲状腺手术的入选标准为：无既往颈部手术史、无放疗史、根据术前计算机断层扫描诊断为良性甲状腺肿瘤、无炎症相关疾病或甲状腺功能亢进、无淋巴结转移、双侧肿瘤直径≤4 cm（一侧≤2 cm，位于甲状腺下部且靠近甲状腺表面）。比较两组的手术方式、并发症、手术时间、美容效果和术后疼痛情况。两组在年龄和性别方面相匹配；手术操作评分（P = 0.443）、术后引流（P = 0.686）和术后疼痛（P = 0.294）差异无统计学意义。无气视频辅助组手术中出血比传统组少，美容效果更好（P < 0.001），但手术时间更长（P = 0.003），住院费用更高（P < 0.001）。两组均未出现永久性喉返神经麻痹或低钙血症，随访21±10个月也无复发。无气视频辅助组有1例出现瘀斑和1例暂时性喉返神经麻痹，但均在1个月内恢复。两组并发症发生率差异无统计学意义（χ = 1.423，P = 0.292）。单侧前胸壁入路无气视频辅助甲状腺切除术是治疗双侧良性甲状腺病变患者的一种安全可行的方法，美容效果良好。无气视频辅助甲状腺切除术是适合特定患者的一种有效手术选择，其应用在未来将会增加。
