完全乳晕入路腔镜甲状腺切除术的远期美容效果的研究

发布时间：2017-12-27 05:05

本文关键词：完全乳晕入路腔镜甲状腺切除术的远期美容效果的研究　出处：《暨南大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:通过比较(endoscopic thyroidectomy via the areola,ETCAA)和(open thyroidectomy,OT)两组患者术后6个月以上的患者对美容满意度疤痕、自我意识评分及观察员对Vancouver疤痕评分,探讨ETCAA的远期美容效果;进行亚组分析比较不同性别、不同年龄、不同术后时间患者的远期美容效果;对两组患者的Vancouver疤痕评分与美容满意度评分及疤痕自我意识评分进行相关性分析,了解疤痕与患者主观满意程度的相关性。方法:纳入2012年10月-2016年1月在广州华侨医院(暨南大学附属第一医院)行甲状腺手术的患者共219例的患者,纳入标准:(1)行双侧切除的甲状腺良性结节或分化型甲状腺癌患者(次全切除/近全切除/全切除);(2)伴或不伴中央区淋巴结清扫者。排除标准:(1)胸骨后甲状腺肿;(2)重度甲亢;(3)行颈外侧淋巴结清扫者;(4)术后发生出血、呼吸困难甚至窒息等OT需要重新拆除颈部原切口缝线或ETCAA另作颈部切口处理者;(5)既往颈部手术或放疗史;(6)凝血功能异常;(7)长期服用抗血小板药物,其中ETCAA组141例,OT组78例,均为双侧甲状腺病变,行双侧切除(次全切除/近全切除/全切除)。对两组术后患者进行门诊随访,未主动返院复诊者予电话了解术后情况并通知其返院,随访时间于术后至少6个月。通过问卷形式收集患者的美容满意度评分、疤痕自我意识评分,并由两位观察员根据Vancouver疤痕评定量表进行Vancouver疤痕评分取平均值,分析两组患者的远期美容效果。继而对两组患者进行性别、不同年龄、不同术后时间等亚组的远期美容效果进行统计学分析。对两组患者的Vancouver疤痕评分与美容满意度评分及疤痕自我意识评分进行相关性分析,了解疤痕的性状与患者主观满意程度的相关性。采用SPSS 17.0统计学软件包进行统计分析,计量资料以x±s表示,计数资料以%表示,P的值0.05为差异有统计学意义。两组患者一般资料及肿块大小采用Student’s t检验和χ2检验;美容满意度评分、疤痕自我意识评分、Vancouver疤痕评分的比较采用Mann-Whitney U秩和检验;Vancouver疤痕评分与美容满意度评分、Vancouver疤痕评分与疤痕自我意识评分的相关性采用Spearman’s相关分析。结果:1、141例患者选择行ETCAA术式,均成功完成,无中转开放情况。ETCAA组的总体远期美容效果优于OT组(P均0.001),其中美容满意度的平均评分ETCAA组值为3.14±2.49,OT组为4.91±3.71(P0.001),疤痕意识度的平均评分ETCAA组为1.62±2.78,OT组为3.29±5.28(P0.001),温哥华评分量表平均得分ETCAA组为1.03±0.68,OT组为2.05±0.84(P0.001)。在本研究中评分系统中,低分对应更满意的美容效,完全乳晕腔镜甲状腺手术方法治疗的患者更满意他们的手术乳房处无疤痕增生或疤痕隐蔽性。2、ETCAA组在美容满意度调查问卷中的Q1或Q2(切口瘢痕)与Q3(颈部的轮廓)的平均值分别为(1.41±0.64,1.73±0.89),比开放组(2.50±0.95,2.41±0.92)(P均0.001)。ETCAA组美容满意度在关于Q1/Q2(切口瘢痕)与Q3(颈部的轮廓)的术后远期美容效果比OT组更好。在疤痕意思调查问卷中,ETCAA组与OT关于Q4(疤痕引起他人的注意程度)的平均得分(P0.001),Q5(尝试隐藏疤痕)的平均得分(P0.001),Q6(你有多常想起你的疤痕)的平均得分(P=0.006)、Q7(你的疤痕是否影响到你的服装选择)的平均值(P=0.006),均有统计学意义。3、Vancouver疤痕评分与美容满意度评分及疤痕自我意识评分存在一定的相关性,提示疤痕的性状与患者主观满意程度有一定关联。温哥华疤痕量表评分为乳房低于对颈部评分(P.001两者)。ETCAA组温哥华疤痕量表评分与美容满意度得分(Spearman的相关系数R=0.224,P=0.670)没有相关性,而与疤痕意识得分(Spearman的相关系数R=0.883,P=0.005)有显著的相关性。OT组温哥华瘢痕量表评分颈部远期美容满意度的满意度得分(Spearman的R=0.860,P=0.013)与疤痕意识得分(Spearman的R=0.857,P=0.002)之间有显著的相关性。4、亚组分析中,两组的男性患者、老年患者的美容满意度及疤痕自我意识评分无显著性差异,ETCAA组与OT组男性美容满意度调查问卷评分平均值为(3.12±1.05,4.32±1.57),P=0.067,在疤痕意识调查问卷平均值为(0.79±1.14,3.15±1.84),P=0.060。年龄大于或等于45岁患者ETCAA组与OT组的美容满意度调查问卷评分平均值为(4.02±1.52,5.02±1.96),(P=0.058),在疤痕意识调查问卷平均值平均值为(1.67±2.43,3.46±3.70)(P=0.054)。5、亚组分析中,术后时间较长的两组患者的美容满意度及疤痕自我意识评分无显著性差异,提示随着时间推移,患者已接受疤痕的存在,不再过于在意。随时间推移,满意度等有所提高,但是ETCAA组还是略胜一筹。随访时间(18月)中ET与OT组的平均值为(12.7±1.34,13.2±1.46),P=0.007,有统计学意义,考虑两者有差别,而随访时间18月时,ETCAA组与OT组的平均值为(22.9±3.15,23.1±3.42),P=0.0542,无显著差异。结论:1、通过数据客观反映使用完全完全乳晕入路腔镜甲状腺切除术的远期美容效果比传统开放手术更好。ETCAA组由于在乳晕处切0.5-1.0cm的小切口,病人虽然知道自己有手术切口,但愈合良好,并且隐蔽,衣服可以将其隐藏。2、疤痕与患者主观满意程度有一定关联。3、男性患者、老年患者的美容满意度及疤痕自我意识评分无显著性差异,提示男性患者及老年患者对于美容需求不太强烈,指导部分患者的术式选择;4、随着时间推移,患者的美容满意度及疤痕自我意识评分无显著性差异,患者已接受疤痕的存在,不再过于在意。随时间推移,满意度等有所提高,但是ETCAA组还是略胜一筹。
[Abstract]:Objective: To compare (endoscopic thyroidectomy via the areola ETCAA (open) and thyroidectomy, OT) for more than 6 months in patients with cosmetic satisfaction scars, self-awareness score and Vancouver score of Observer Scar after operation in the two groups, the capacity of ETCAA to investigate the long term effect; long term curative effects in patients with time for subgroup analysis comparison of different gender, different age and postoperative; scores of two groups of patients with Vancouver score and scar cosmetic satisfaction and scar self consciousness score correlation analysis to understand the correlation between the scar and the patient satisfaction. Methods: in October 2012 -2016 January in Guangzhou Overseas Chinese Hos (the First Affiliated Hospital of Jinan University) for thyroid surgery patients with a total of 219 cases of patients with inclusion criteria: (1) for benign thyroid nodules or differentiated thyroid cancer patients with bilateral resection (subtotal / subtotal resection /); (2) with or without with central lymph node dissection. Exclusion criteria: (1) substernal goiter; (2) severe hyperthyroidism; (3) for lateral cervical lymph node dissection; (4) bleeding, dyspnea and suffocation OT need to remove the original neck incision suture or other ETCAA neck incision treatment after operation; (5) previous neck surgery or a history of radiation; (6) abnormal coagulation function; (7) the long-term use of antiplatelet drugs, including 141 cases of ETCAA group, OT group of 78 cases were bilateral thyroid lesions, underwent bilateral resection (subtotal / subtotal resection /). Two groups of patients were followed up in the outpatient department. The patients who had not returned to the hospital received the telephone to know the postoperative situation and notify the return hospital. The follow-up time was at least 6 months after the operation. The patients' cosmetic satisfaction score and scar self consciousness score were collected through questionnaires, and the average score of Vancouver scars was evaluated by two observers according to the Vancouver scar rating scale. The long-term cosmetic results of two groups were analyzed. Then the long-term beauty effect of the subgroups, such as sex, age and time after operation, were statistically analyzed in the two groups. Two groups of patients with Vancouver scar score and cosmetic satisfaction score and scar self consciousness score correlation analysis, to understand the correlation between scar characteristics and patients' subjective satisfaction degree. The statistical analysis was carried out by SPSS 17 statistics software package. The measurement data were expressed in X + s. The count data were expressed as%, and the value of P was 0.05. General data of the two groups and the size of the tumor patients' s Student t test and 2 test; compared with the cosmetic satisfaction score, Vancouver score, self consciousness scar scar score Mann-Whitney U test; Vancouver scar score and cosmetic satisfaction score, Vancouver score and scar scar self consciousness score correlation using Spearman 's analysis. Results: 1, 141 patients were selected for ETCAA operation and were successfully completed. The overall effect of cosmetic is better than that of OT group and ETCAA group (P 0.001), the average score of ETCAA beauty satisfaction value is 3.14 + 2.49 group, OT group is 4.91 + 3.71 (P0.001), the average score of consciousness ETCAA scar group is 1.62 + 2.78, OT group is 3.29 + 5.28 (P0.001), Vancouver the average rating scale score of ETCAA group is 1.03 + 0.68, OT group is 2.05 + 0.84 (P0.001). In this study, the score system is more satisfactory than the low score. The patients with complete areola endoscopic thyroidectomy are more satisfied with their scar free or scar concealment. 2, the average value of Q1 or Q2 (incision scar) and Q3 (neck contour) in ETCAA satisfaction questionnaire is (1.41 + 0.64,1.73 + 0.89), which is higher than that in open group (2.50 + 0.95,2.41 + 0.92) (P 0.001). The beauty satisfaction of group ETCAA was better than that of group OT in the long term cosmetic effect on Q1/Q2 (incision scar) and Q3 (neck contour). In the mean scar questionnaire, ETCAA group and OT Q4 (on the degree of attention of others caused by scar) the average score (P0.001), Q5 (try to hide scars) the average score (P0.001), Q6 (how often do you think of your scar) the average score (P=0.006), Q7 (your scars whether affect your choice of clothing) the average value (P=0.006), were statistically significant. 3, there is a certain correlation between Vancouver scar score and cosmetic satisfaction score and scar self consciousness score, suggesting that there is a certain correlation between the characteristics of scar and subjective satisfaction of patients. The Vancouver scar scale was scored for the breasts below the neck score (P.001). There was no correlation between the score of Vancouver scar scale and the score of cosmetic satisfaction (Spearman correlation coefficient R=0.224, P=0.670) in group ETCAA, but it was significantly correlated with the score of scar consciousness (Spearman correlation coefficient R=0.883, P=0.005). Group OT Vancouver scar scale score, cervical long-term beauty satisfaction satisfaction score (Spearman R=0.860, P=0.013) was significantly correlated with scar awareness score (Spearman R=0.857, P=0.002). 4, subgroup analysis, cosmetic satisfaction and scar of male patients and two groups of elderly patients with self awareness scores had no significant difference, ETCAA group and OT group of male beauty satisfaction questionnaire scoring average (3.12 + 1.05,4.32 + 1.57), P=0.067 in scar questionnaire average consciousness (0.79. 1.14,3.15 + 1.84), P=0.060. The average score of cosmetic satisfaction questionnaire for ETCAA group and OT group was (4.02 + 1.52,5.02 + 1.96), and the average value of scar awareness questionnaire was (1.67 + 2.43,3.46 + 3.70) (P=0.054). The average age of the patients in the group ETCAA and group 1.52,5.02 was 45. 5, in the subgroup analysis, there was no significant difference in cosmetic satisfaction and scar self consciousness score between the two groups of patients with longer postoperative time, suggesting that over time, the patients had accepted the existence of scar and no longer care much about it. Over time, satisfaction has increased, but the ETCAA group or a stroke above. ET and ET during the follow-up time (month)
【学位授予单位】：暨南大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R653

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