经口与经颈甲状腺切除术后的美容效果。

Cosmetic outcomes following transoral versus transcervical thyroidectomy.

作者信息

Chen Lena W, Razavi Christopher R, Hong Hanna, Fondong Akeweh, Ranganath Rohit, Khatri Surya, Mydlarz Wojciech K, Mathur Aarti, Ishii Masaru, Nellis Jason, Shaear Mohammad, Tufano Ralph P, Russell Jonathon O

机构信息

Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

出版信息

Head Neck. 2020 Nov;42(11):3336-3344. doi: 10.1002/hed.26383. Epub 2020 Aug 6.

DOI:10.1002/hed.26383

PMID:32767458

Abstract

BACKGROUND

Central neck scars following thyroidectomy can negatively impact patient quality of life. Transoral endoscopic thyroidectomy can reduce postoperative cosmetic burden.

METHODS

Prospective cohort study of patients seen between June 2018 and January 2019. Scar cosmesis was determined using the validated Scar Cosmesis Assessment and Rating (SCAR) scale and a Visual Analog Scale (VAS) measuring color, contour, and irregularity.

RESULTS

Eighty-one patients (80% female, mean age 43.7 years) were analyzed, with 60% and 40% receiving transcervical and transoral thyroidectomy. Median time from surgery was 3.4 (range: 1-37.1) weeks. Mean SCAR score was greater for transcervical recipients (4.69 vs transoral 0.99, P < .001), indicating worse cosmesis. Mean surgeon-rated total VAS score was similarly increased for transcervical recipients (72.84 vs transoral 16.73, P < .001). Interrater reliability for both SCAR and total VAS scores was excellent (intraclass correlation 0.93; 95% CI: 0.90-0.95 for both).

CONCLUSION

Transoral thyroidectomy provides significantly enhanced early cosmesis over the transcervical approach.

摘要

背景

甲状腺切除术后颈部中央瘢痕会对患者生活质量产生负面影响。经口内镜甲状腺切除术可减轻术后美容负担。

方法

对2018年6月至2019年1月期间就诊的患者进行前瞻性队列研究。使用经过验证的瘢痕美容评估和评分（SCAR）量表以及测量颜色、轮廓和不规则度的视觉模拟量表（VAS）来确定瘢痕美容效果。

结果

对81例患者（80%为女性，平均年龄43.7岁）进行了分析，其中60%和40%的患者分别接受了经颈和经口甲状腺切除术。手术至评估的中位时间为3.4周（范围：1 - 37.1周）。经颈手术患者的平均SCAR评分更高（4.69 vs经口手术患者的0.99，P < 0.001），表明美容效果更差。经颈手术患者的外科医生评定的总VAS评分同样更高（72.84 vs经口手术患者的16.73，P < 0.001）。SCAR评分和总VAS评分的评分者间信度均极佳（组内相关系数为0.93；两者的95%置信区间均为0.90 - 0.95）。