本文關鍵詞：完全乳暈入路腔鏡甲狀腺切除術的遠期美容效果的研究　出處：《暨南大學》2016年碩士論文　論文類型：學位論文

  更多相關文章： 內鏡 甲狀腺切除術 完全乳暈入路 美容效果 遠期

【摘要】：目的:通過比較(endoscopic thyroidectomy via the areola,ETCAA)和(open thyroidectomy,OT)兩組患者術后6個月以上的患者對美容滿意度疤痕、自我意識評分及觀察員對Vancouver疤痕評分,探討ETCAA的遠期美容效果;進行亞組分析比較不同性別、不同年齡、不同術后時間患者的遠期美容效果;對兩組患者的Vancouver疤痕評分與美容滿意度評分及疤痕自我意識評分進行相關性分析,了解疤痕與患者主觀滿意程度的相關性。方法:納入2012年10月-2016年1月在廣州華僑醫(yī)院(暨南大學附屬第一醫(yī)院)行甲狀腺手術的患者共219例的患者,納入標準:(1)行雙側切除的甲狀腺良性結節(jié)或分化型甲狀腺癌患者(次全切除/近全切除/全切除);(2)伴或不伴中央?yún)^(qū)淋巴結清掃者。排除標準:(1)胸骨后甲狀腺腫;(2)重度甲亢;(3)行頸外側淋巴結清掃者;(4)術后發(fā)生出血、呼吸困難甚至窒息等OT需要重新拆除頸部原切口縫線或ETCAA另作頸部切口處理者;(5)既往頸部手術或放療史;(6)凝血功能異常;(7)長期服用抗血小板藥物,其中ETCAA組141例,OT組78例,均為雙側甲狀腺病變,行雙側切除(次全切除/近全切除/全切除)。對兩組術后患者進行門診隨訪,未主動返院復診者予電話了解術后情況并通知其返院,隨訪時間于術后至少6個月。通過問卷形式收集患者的美容滿意度評分、疤痕自我意識評分,并由兩位觀察員根據(jù)Vancouver疤痕評定量表進行Vancouver疤痕評分取平均值,分析兩組患者的遠期美容效果。繼而對兩組患者進行性別、不同年齡、不同術后時間等亞組的遠期美容效果進行統(tǒng)計學分析。對兩組患者的Vancouver疤痕評分與美容滿意度評分及疤痕自我意識評分進行相關性分析,了解疤痕的性狀與患者主觀滿意程度的相關性。采用SPSS 17.0統(tǒng)計學軟件包進行統(tǒng)計分析,計量資料以x±s表示,計數(shù)資料以%表示,P的值0.05為差異有統(tǒng)計學意義。兩組患者一般資料及腫塊大小采用Student’s t檢驗和χ2檢驗;美容滿意度評分、疤痕自我意識評分、Vancouver疤痕評分的比較采用Mann-Whitney U秩和檢驗;Vancouver疤痕評分與美容滿意度評分、Vancouver疤痕評分與疤痕自我意識評分的相關性采用Spearman’s相關分析。結果:1、141例患者選擇行ETCAA術式,均成功完成,無中轉開放情況。ETCAA組的總體遠期美容效果優(yōu)于OT組(P均0.001),其中美容滿意度的平均評分ETCAA組值為3.14±2.49,OT組為4.91±3.71(P0.001),疤痕意識度的平均評分ETCAA組為1.62±2.78,OT組為3.29±5.28(P0.001),溫哥華評分量表平均得分ETCAA組為1.03±0.68,OT組為2.05±0.84(P0.001)。在本研究中評分系統(tǒng)中,低分對應更滿意的美容效,完全乳暈腔鏡甲狀腺手術方法治療的患者更滿意他們的手術乳房處無疤痕增生或疤痕隱蔽性。2、ETCAA組在美容滿意度調查問卷中的Q1或Q2(切口瘢痕)與Q3(頸部的輪廓)的平均值分別為(1.41±0.64,1.73±0.89),比開放組(2.50±0.95,2.41±0.92)(P均0.001)。ETCAA組美容滿意度在關于Q1/Q2(切口瘢痕)與Q3(頸部的輪廓)的術后遠期美容效果比OT組更好。在疤痕意思調查問卷中,ETCAA組與OT關于Q4(疤痕引起他人的注意程度)的平均得分(P0.001),Q5(嘗試隱藏疤痕)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(你的疤痕是否影響到你的服裝選擇)的平均值(P=0.006),均有統(tǒng)計學意義。3、Vancouver疤痕評分與美容滿意度評分及疤痕自我意識評分存在一定的相關性,提示疤痕的性狀與患者主觀滿意程度有一定關聯(lián)。溫哥華疤痕量表評分為乳房低于對頸部評分(P.001兩者)。ETCAA組溫哥華疤痕量表評分與美容滿意度得分(Spearman的相關系數(shù)R=0.224,P=0.670)沒有相關性,而與疤痕意識得分(Spearman的相關系數(shù)R=0.883,P=0.005)有顯著的相關性。OT組溫哥華瘢痕量表評分頸部遠期美容滿意度的滿意度得分(Spearman的R=0.860,P=0.013)與疤痕意識得分(Spearman的R=0.857,P=0.002)之間有顯著的相關性。4、亞組分析中,兩組的男性患者、老年患者的美容滿意度及疤痕自我意識評分無顯著性差異,ETCAA組與OT組男性美容滿意度調查問卷評分平均值為(3.12±1.05,4.32±1.57),P=0.067,在疤痕意識調查問卷平均值為(0.79±1.14,3.15±1.84),P=0.060。年齡大于或等于45歲患者ETCAA組與OT組的美容滿意度調查問卷評分平均值為(4.02±1.52,5.02±1.96),(P=0.058),在疤痕意識調查問卷平均值平均值為(1.67±2.43,3.46±3.70)(P=0.054)。5、亞組分析中,術后時間較長的兩組患者的美容滿意度及疤痕自我意識評分無顯著性差異,提示隨著時間推移,患者已接受疤痕的存在,不再過于在意。隨時間推移,滿意度等有所提高,但是ETCAA組還是略勝一籌。隨訪時間(18月)中ET與OT組的平均值為(12.7±1.34,13.2±1.46),P=0.007,有統(tǒng)計學意義,考慮兩者有差別,而隨訪時間18月時,ETCAA組與OT組的平均值為(22.9±3.15,23.1±3.42),P=0.0542,無顯著差異。結論:1、通過數(shù)據(jù)客觀反映使用完全完全乳暈入路腔鏡甲狀腺切除術的遠期美容效果比傳統(tǒng)開放手術更好。ETCAA組由于在乳暈處切0.5-1.0cm的小切口,病人雖然知道自己有手術切口,但愈合良好,并且隱蔽,衣服可以將其隱藏。2、疤痕與患者主觀滿意程度有一定關聯(lián)。3、男性患者、老年患者的美容滿意度及疤痕自我意識評分無顯著性差異,提示男性患者及老年患者對于美容需求不太強烈,指導部分患者的術式選擇;4、隨著時間推移,患者的美容滿意度及疤痕自我意識評分無顯著性差異,患者已接受疤痕的存在,不再過于在意。隨時間推移,滿意度等有所提高,但是ETCAA組還是略勝一籌。
[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)
【學位授予單位】：暨南大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R653

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