3D腔镜技术在分化型甲状腺癌手术中的临床应用研究

发布时间：2019-01-21 13:44

【摘要】：目的:目前,治疗甲状腺癌的手术方式有传统开放及腔镜两种,腔镜又分为二维及三维系统。三维腔镜应用于外科手术疗效受到广泛认可,然而,其应用于甲状腺癌手术的临床研究却甚少,未能充分体现3D腔镜在治疗甲状腺癌上的优势。本文通过对比3D腔镜、2D腔镜及开放手术三种方式治疗分化型甲状腺癌的临床实际疗效及其对机体炎症反应的影响,来探讨3D腹腔镜在甲状腺全切联合中央区淋巴结清扫术中的应用价值。方法:通过回顾性分析于2013年09月至2016年04月在南方医科大学珠江医院普通外科就诊的90例分化型甲状腺癌患者的临床资料,根据手术方式不同分为3D腔镜组、2D腔镜组及开放组三组,每组病例数均为30例,入围病例均经术后石蜡病理结果确诊为分化型甲状腺癌。腔镜组均采用经胸乳入路手术方案,开放手术组采用颈部低衣领式切口。比较三组患者手术时间、术中出血量、术后颈部引流管引流量、术后住院天数、术后病理提示淋巴结个数及淋巴结转移个数、住院费用等临床指标,术后不良反应及炎症指标等,应用统计学软件对数据进行处理分析,并得出结论。结果:通过统计学软件对数据进行分析处理后显示,与开放组、2D腔镜组相比,3D腔镜组术中出血量更少,3D腔镜组与开放组相比术后不良反应发生率低,其中以术后头晕呕吐等不适反应发生率低为主,且3D腔镜组无一例患者术后出现声音嘶哑、饮水呛咳等甲状腺手术主要并发症。3D腔镜组相对于2D腔镜组手术时间缩短(P0.05),平均缩短约22min。腔镜组间总住院费用无明显差异,2D住院总费用约18050±129元,3D组住院总费用约19675±1147元,3D腔镜组与传统2D腔镜组相比并不会增加患者的住院费用。3D组与其他两组相比术后引流量差异无统计学意义。三者间术后住院时间、淋巴结清扫个数、中央区淋巴结转移个数以及手术对机体炎症反应的影响等差异不具统计学意义(P0.05)。结论:3D腔镜技术行甲状腺全切联合中央区淋巴结清扫术是安全、有效的,与传统2D腔镜及开放手术相比,可明显减少术中出血量,且与2D腔镜相比手术时间大大减少的同时并不会增加患者额外经济负担。与开放手术相比,3D腔镜可明显降低围手术期不良反应发生率。传统观念认为,腔镜甲状腺手术因其需建立皮下隧道而增加对机体的创伤。本研究表明:腔镜组与开放组之间炎症指标差异无统计学意义,提示腔镜手术并不会增加对患者的创伤影响。因此,3D腔镜手术具有术中出血量少、可减少术后不良反应发生率、美容效果好、对机体创伤影响小等特点,可作为分化型甲状腺癌手术的重要选择方式。
[Abstract]:Objective: at present, there are two kinds of operative methods for thyroid carcinoma: traditional open and endoscopy, which can be divided into two-dimensional and three-dimensional systems. The effect of 3D endoscopy in surgical treatment is widely accepted, however, there are few clinical studies on its application in thyroid cancer surgery, which fails to fully reflect the advantages of 3D endoscopy in the treatment of thyroid carcinoma. In this paper, we compared the clinical effect of 3D endoscopy, 2D endoscopy and open operation on differentiated thyroid carcinoma and its effect on inflammatory reaction. To evaluate the value of 3 D laparoscopy in total thyroidectomy combined with central lymph node dissection. Methods: the clinical data of 90 patients with differentiated thyroid carcinoma from September 2013 to April 2016 in Zhujiang Hospital of Southern Medical University were retrospectively analyzed. There were 30 cases in each group in 2D endoscopic group and open group. All cases were confirmed as differentiated thyroid carcinoma by paraffin wax pathological results after operation. The endoscopic group was treated by transthoracic approach, and the open group was treated with low collar neck incision. The time of operation, the amount of blood lost during operation, the drainage flow of cervical drainage tube, the days of hospitalization, the number of lymph nodes, the number of lymph node metastasis, the cost of hospitalization were compared among the three groups. The adverse reaction and inflammation index were analyzed by statistical software, and the conclusion was drawn. Results: the data were analyzed and processed by statistical software. Compared with the open group and 2D group, the volume of intraoperative bleeding was less in the 3D endoscopic group, and the incidence of postoperative adverse reactions was lower in the 3D endoscopic group than in the open group. Among them, the incidence of postoperative discomfort such as dizziness and vomiting was low, and none of the patients in the 3D endoscopic group had hoarseness after operation. The operative time of 3D endoscopic group was shorter than that of 2D endoscopic group (P0.05), and the average shortening was about 22 mins. There was no significant difference in total hospitalization cost between endoscopic group and 3D group. The total cost of 2D hospitalization was 18050 卤129.The total cost of 3D group was about 19675 卤1147 yuan. The cost of hospitalization was not increased in 3D group compared with the traditional 2D group. There was no significant difference in postoperative drainage between 3D group and other two groups. There were no significant differences among the three groups in the length of hospitalization, the number of lymph nodes dissection, the number of lymph node metastasis in the central area and the effect of operation on the inflammatory response of the body (P0.05). Conclusion: total thyroidectomy combined with central lymph node dissection is safe and effective. Compared with traditional 2D endoscopy and open surgery, the amount of intraoperative bleeding can be significantly reduced. And compared with 2 D endoscopy, the operation time is greatly reduced, and does not increase the additional economic burden of patients. Compared with open surgery, 3D endoscopy can significantly reduce the incidence of perioperative adverse reactions. Traditionally, endoscopic thyroid surgery has increased the trauma due to the need to build subcutaneous tunnels. This study showed that there was no significant difference in inflammatory markers between the endoscopic group and the open group, suggesting that endoscopic surgery did not increase the traumatic impact on patients. Therefore, 3D endoscopic surgery has the characteristics of less intraoperative bleeding, less postoperative adverse reactions, better cosmetic effect and less impact on body trauma. It can be used as an important choice for differentiated thyroid carcinoma surgery.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R736.1

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