完全腔镜甲状腺手术中缩小胸壁分离范围与传统分离范围的长期随访研究

发布时间：2018-04-22 22:29

本文选题：完全腔镜甲状腺手术 + 缩小胸壁分离范围　；参考：《山东大学》2015年硕士论文

【摘要】：目的：目前完全腔镜甲状腺手术胸前区的游离已经改良为缩小胸壁分离范围的腔镜甲状腺手术(endoscopicthyroidectomy using the improving chest separation methods),其胸前区皮下游离范围较传统分离范围小,对于两种术式的愈后暂无较多对比研究。本文将通过对两种术式的安全性、创伤性及美容性等方面做出对比,以评价两种术式的优势与不足。以期对缩小胸壁分离范围的完全腔镜甲状腺手术进行优劣评价。方法：研究包含了山东大学齐鲁医院自2011年至2014年收治并决定行完全腔镜甲状腺手术的患者共117人,其中行传统胸壁分离范围腔镜手术的患者43人,行缩小胸壁分离范围腔镜手术的患者74人。统计患者的性别、年龄、手术有关数据、住院时间、患者主观感受、美容效果满意度等方面数据并做出分析,已评价两种术式在各个方面的差异。资料收集通过查询病历、调查问卷及电话随访等方式实现。结果：(1)手术情况：两组患者平均年龄、肿瘤大小和良恶性比例均无显著差异。所有手术术中喉返神经均连续性完好或术中神经监测信号均完好。术中出血无明显差异(23.3±6.72ml vs 26.5±7.65ml,P0.05)。(2)术后情况：术后6h、12h及24h疼痛评分VAS (Visual analogue scales,视觉模糊评分)两组无显著差异；术后3天RSI评分(The Reflux Symptom Index,反流症状指数量表)无显著差异(23.2±7.21 vs 26.1±6.80,P0.05)；术后引流量缩小胸壁分离组明显小于传统分离组(95.1±40.50ml vs 121.3±30.65ml P0.05),患者住院天数(4.0±1.32天vs 4.0±1.43天,P0.05)无显著差异；术后3个月随访VHI (Voice Handicap Index,噪音障碍指数)无显著差异(21.6±4.39vs 22.7±3.42,P0.05)；术后长期随访感觉和外观量表,两组患者的颈部疼痛及不适的结果中,均在术后1-3个月内相对于术前有明显差异,两组之间在长期随访中组间并无明显差异；对于两组患者的胸前区疼痛及不适的结果中,胸前区疼痛方面,缩小胸壁分离术式在术后6个月内相对于术前有明显差异(0.08±0.27,0.20±0.40,P=0.035),传统分离方式至术后1年仍与术前相比有明显差异(0.05±0.21,0.25±0.44,P=0.007)。两组之间在术后3个月有明显差异(0.35±0.48,0.79±0.63,P0.01)；胸前区不适在术后6个月内相对于术前有明显差异,两组之间在术后3个月有明显差异(0.22±0.41,0.93±0.63,P0.01),胸前区感觉异常至术后随访6个月内相对于术前均有明显差异,两组之间在术后3个月有明显差异(0.45±0.50,0.95±0.75,P0.01)；患者满意度评分两组无明显差异(3.7±0.46 vs 3.8±0.37,P0.05)。结论：在完全腔镜甲状腺手术中缩小胸壁分离范围术式与传统分离范围术式相比,在安全性方面类似,均为安全可靠的手术方式,术后患者对美容方面的满意度相似,但创伤性及术后恢复有统计学意义,结果显示在完全腔镜甲状腺手术中缩小胸壁分离范围术式比传统分离范围术式的创伤小,术后不适较轻,且术后恢复较快。故缩小胸壁分离范围的术式要优于传统分离范围术式。
[Abstract]:Objective : To evaluate the advantages and disadvantages of two kinds of operation methods . The results were as follows : ( 1 ) There were no significant differences in the mean age , tumor size and good malignant ratio between two groups . Results : ( 1 ) There was no significant difference in the mean age , tumor size and good malignant ratio of the patients .
There was no significant difference ( 23.2 卤 7.21 vs 26.1 卤 6.80 , P0.05 ) .
After operation , the chest wall separation group was significantly smaller than that in the conventional separation group ( 95.1 卤 40.50 ml vs 121.3 卤 30.65 ml P0.05 ) , and the number of days in hospital stay was 4.0 卤 1.32 days vs 4.0 卤 1.43 days , P0.05 ) .
There was no significant difference in the follow - up VHI at the 3 - month follow - up ( 21.6 卤 4.39 vs 22 . 7 卤 3.42 , P < 0 . 05 ) .
Long - term follow - up feeling and appearance scale showed that the pain and discomfort of the neck were significantly different between the two groups within 1 - 3 months after operation , and there was no significant difference between the two groups during long - term follow - up .
There was a significant difference between the two groups ( 0 . 05 卤 0 . 21 , 0 . 25 卤 0 . 44 , P = 0.007 ) . There was a significant difference between the two groups ( 0 . 35 卤 0 . 48 , 0.79 卤 0.63 , P0.01 ) .
There was a significant difference between the two groups ( 0.22 卤 0.41 , 0.93 卤 0.63 , P0.01 ) . There was a significant difference between the two groups ( 0.45 卤 0.50 , 0.95 卤 0.75 , P0.01 ) .
There was no significant difference between the two groups ( 3.7 卤 0.46 vs 3.8 卤 0.37 , P0.05 ) . Conclusion : Compared with the traditional separation range , the reduction of chest wall separation range in total endoscopic thyroid surgery is safe and reliable , and the patient ' s satisfaction with cosmetic is similar , but the traumatic and postoperative recovery has statistical significance . The results show that the reduction of chest wall separation range is better than that in traditional separation range .

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R653

【参考文献】