标题：腹腔镜下经胸乳路径用于甲状腺肿瘤手术治疗的价值

      作者：陈怡，曹强，杨佳员，高成栋，卓飞    西安市长安区医院普通外科，陕西 西安 710100

      卷次： 2021年32卷22期

      【摘要】 目的 分析腹腔镜下经胸乳路径用于甲状腺肿瘤手术治疗的临床价值。方法 选取2018年4月至2020年9月在西安市长安区医院拟行甲状腺肿瘤手术治疗的118例患者，采用随机数表法均分为两组，其中对照组59例采用传统开放手术，研究组59例采用腹腔镜下经胸乳路径甲状腺肿瘤根治术。比较两组患者的围术期指标(术中出血量、手术时间、肿物质量、术后引流量、住院时间、切口长度)和术后并发症(声音嘶哑、切口感染、术后出血、疼痛程度、血肿形成、麻木抽搐)情况。在术后1 d、7 d采用温哥华瘢痕量表(VSS)评价瘢痕情况，采用语言描述(疼痛)评分(VRS)法评价疼痛情况。结果 研究组患者术中出血量为(23.49±6.71) mL、术后引流量为(5.13±1.63) mL、住院时间为(4.85±1.41) d、切口长度为(2.57±0.67) cm，明显少(短)于对照组的(34.83±7.42) mL、(7.85±1.71) mL、(7.63±1.43) d、(6.53±1.22) cm，差异均有统计学意义(P<0.05)；两组患者的手术时间、肿物质量比较差异均无统计学意义(P>0.05)；研究组患者术后 1 d、7 d瘢痕评分分别为(6.03±1.03)分、(3.04±0.74)分、疼痛评分分别为(3.48±0.64)分、(2.14±0.28)分，明显低于对照组的(8.35±1.58)分、(5.35±1.58)分和(5.49±1.06)分、(2.56±0.43)分，差异均有统计学意义(P<0.05)；术前两组患者的hs-CRP、IL-6、TNF-α水平比较差异均无统计学意义(P>0.05)，术后研究组患者的hs-CRP、IL-6、TNF-α水平分别为(12.58±1.81) mg/L、(38.28±6.51) ng/L、(24.32±5.22) ng/L，明显低于对照组的(13.39±1.96) mg/L、(47.62±7.49) ng/L、(38.44±4.54) ng/L，差异均有统计学意义(P<0.05)；研究组患者术后并发症发生率为5.08%，明显低于对照组的20.34%，差异有统计学意义(P<0.05)。结论 腹腔镜下经胸乳路径用于甲状腺肿瘤手术治疗能显著减轻患者疼痛感与机体损伤，在降低并发症的同时，提升美观程度。
      【关键词】 腹腔镜；甲状腺；胸乳路径；开放手术；切口长度；疼痛
      【中图分类号】 R736.1 【文献标识码】 A 【文章编号】 1003—6350（2021）22—2925—04

Value of laparoscopic transthoracic approach in the surgical treatment of thyroid tumors.
CHEN Yi , CAO Qiang,YANG Jia-yuan, GAO Cheng-dong, ZHUO Fei. Department of General Surgery, Xi'an Chang'an District Hospital, Xi'an710100, Shaanxi, CHINA
【Abstract】 Objective To analyze the value of laparoscopic transthoracic approach in the treatment of thyroidtumor. Methods A total of 118 cases of thyroid tumor surgery in Xi'an Chang'an District Hospital from April 2018 toSeptember 2020 were selected and randomly divided into two groups: the control group (59 cases) recieved traditionalopen surgery, and the study group (59 cases) received laparoscopic radical thyroidectomy via breast approach. The peri-operative indexes (intraoperative blood loss, operation time, weight of tumor, postoperative drainage, length of hospitalstay, incision length), postoperative complications (hoarseness, incision infection, postoperative bleeding, degree of pain,hematoma formation, numbness and convulsion) of the two groups were observed. At 1 day and 7 days after operation,Vancouver Scar Scale (VSS) was used to evaluate the scar, and VRS was used to evaluate the pain. Results In thestudy group, the intraoperative blood loss, postoperative drainage, length of hospital stay, and incision length were(23.49±6.71) mL, (5.13±1.63) mL, (4.85±1.41) d, (2.57±0.67) cm, which were significantly lower than (34.83±7.42) mL,(7.85±1.71) mL, (7.63±1.43) d, (6.53±1.22) cm in the control group (P<0.05). There was no significant difference in opera-tion time and tumor weight between the two groups (P>0.05). In the study group, the scar score was (6.03±1.03) points and(3.04±0.74) points at 1 day and 7 days after operation, and pain score was (3.48±0.64) points and (2.14±0.28) points,which were significantly lower than (8.35±1.58) points and (5.35±1.58) points, (5.49±1.06) points and (2.56±0.43) pointsin the control group (P<0.05). There was no significant difference in the level of hs-CRP, IL-6, and TNF-α between thetwo groups before operation (P>0.05); after operation, the levels of hs-CRP, IL-6, and TNF-α in the study group were(12.58±1.81) mg/L, (38.28±6.51) ng/L, (24.32±5.22) ng/L, which were significantly lower than (13.39±1.96) mg/L,(47.62±7.49) ng/L, (38.44±4.54) ng/L in the control group (P<0.05). The incidence of postoperative complications in thestudy group was 5.08% , significantly lower than 20.34% in the control group (P<0.05). Conclusion Laparoscopictransthoracic approach for thyroid tumor surgery can significantly reduce the pain and body damage of patients, reducecomplications and improve the aesthetic level.
      【Key words】 Laparoscopy; Thyroid; Breast approach; Open surgery; Incision length; Pain