Dimov R, Kanchev R, Apostolov I, Boev B, Ivanov T, Hinov A, Doikov I, Cheshmedzhiev N, Mitev K, Spasov Y, Dimova R
Department of Surgery, Kaspela General Hospital for Active Treatment, Plovdiv, Bulgaria.
Department of Anaesthesiology, Kaspela General Hospital for Active Treatment, Plovdiv, Bulgaria.
Khirurgiia (Sofiia). 2013(3):14-9.
After the introduction of minimally invasive operative techniques in the surgery of organs located in body cavities, extensive work has been done in the last five years with respect to their application in thyroid gland surgery as well.
In 2011, 406 patients underwent thyroid surgery at the Department of Surgery, Kaspela General Hospital for Active Treatment EOOD - Plovdiv. The study involved 48 of these patients, chosen at random and divided into two groups (A-minimally invasive thyroidectomy (MIT) - 26 patients, and B - minimally invasive video-assisted thyroidectomy (MIVAT) - 22 patients). All patients included in the study were selected on the basis of presence of one or more indeterminate nodules (fine needle aspiration biopsy - FNAB) sized up to 3.5 cm, with normal size of the thyroid gland up to 20-25 cm2, detected by preoperative ultrasonography. The study excluded patients with recurrent goitre, malignant disease of the thyroid gland and evidence of preoperative radiation therapy in the area of the head, neck and/or upper mediastinum. The preoperative investigation included history, physical examination, blood indices, echography, gamma camera and FNAB. Sensation of pain was evaluated by the patients according to a visual analogue scale, where lack of pain was evaluated as 0, and the most severe pain was evaluated as 10.
The average duration of the hospitalization of patients undergoing MIT was 16 +/- 3.14 hours, whereas the patients undergoing MIVAT had to stay at the hospital for 18 +/- 3.56 hours. No complications were registered regarding the recurrent laryngeal nerves (RLN), as well as the operative wound. It should be noted that in all patients the course of the respective RLN was identified during the operative intervention, visually in most cases, or by electrostimulation. Postoperative hypoparathyroidism, registered by measuring the level of serum calcium, was observed in one visual analogue scale, as well as in the administration of pain-relieving agents during hospitalization. Other complications were not registered for the follow-up period, which covered an average of 6.56 +/- 3.14 months.
The clinical analysis of the patients observed gave us grounds to draw the following conclusions: 1. The minimally invasive approach in patients with thyroid gland pathology is a possible and favourable option in selected patients with size of the gland within certain limits and not suffering from severe concomitant diseases. 2. The results in both groups of patients were comparable and did not show significant difference.
在体腔器官手术中引入微创技术后，过去五年在其应用于甲状腺手术方面也开展了大量工作。
2011年，卡斯特拉综合医院积极治疗有限责任公司（位于普罗夫迪夫）外科有406例患者接受了甲状腺手术。本研究纳入了其中48例患者，随机分为两组（A组——微创甲状腺切除术（MIT）——26例患者，B组——微创视频辅助甲状腺切除术（MIVAT）——22例患者）。纳入本研究的所有患者均基于存在一个或多个直径达3.5 cm的不确定结节（细针穿刺活检——FNAB）且术前超声检查显示甲状腺大小正常（达20 - 25 cm²）入选。本研究排除了复发性甲状腺肿患者、甲状腺恶性疾病患者以及头、颈和/或上纵隔区域有术前放疗证据的患者。术前检查包括病史、体格检查、血液指标、超声检查、γ相机检查和FNAB。患者根据视觉模拟评分法评估疼痛感觉，无痛评为0分，最剧烈疼痛评为10分。
接受MIT的患者平均住院时间为16 ± 3.14小时，而接受MIVAT的患者需住院18 ± 3.56小时。未记录到关于喉返神经（RLN）以及手术切口的并发症。应当指出，在所有患者中，术中均识别出了各自RLN的走行，多数情况下通过直视，或通过电刺激。通过测量血清钙水平记录到术后甲状旁腺功能减退在一名患者中出现，住院期间疼痛缓解药物的使用情况也按视觉模拟评分法进行了记录。随访期平均为6.56 ± 3.14个月，未记录到其他并发症。
对观察到的患者进行临床分析使我们有理由得出以下结论：1. 对于甲状腺疾病患者，微创方法在腺体大小在一定范围内且无严重合并症的特定患者中是一种可行且有利的选择。2. 两组患者的结果具有可比性，未显示出显著差异。
