本文選題：完全腔鏡甲狀腺手術(shù) + 縮小胸壁分離范圍��； 參考：《山東大學(xué)》2015年碩士論文

【摘要】：目的：目前完全腔鏡甲狀腺手術(shù)胸前區(qū)的游離已經(jīng)改良為縮小胸壁分離范圍的腔鏡甲狀腺手術(shù)(endoscopicthyroidectomy using the improving chest separation methods),其胸前區(qū)皮下游離范圍較傳統(tǒng)分離范圍小,對于兩種術(shù)式的愈后暫無較多對比研究。本文將通過對兩種術(shù)式的安全性、創(chuàng)傷性及美容性等方面做出對比,以評(píng)價(jià)兩種術(shù)式的優(yōu)勢與不足。以期對縮小胸壁分離范圍的完全腔鏡甲狀腺手術(shù)進(jìn)行優(yōu)劣評(píng)價(jià)。方法：研究包含了山東大學(xué)齊魯醫(yī)院自2011年至2014年收治并決定行完全腔鏡甲狀腺手術(shù)的患者共117人,其中行傳統(tǒng)胸壁分離范圍腔鏡手術(shù)的患者43人,行縮小胸壁分離范圍腔鏡手術(shù)的患者74人。統(tǒng)計(jì)患者的性別、年齡、手術(shù)有關(guān)數(shù)據(jù)、住院時(shí)間、患者主觀感受、美容效果滿意度等方面數(shù)據(jù)并做出分析,已評(píng)價(jià)兩種術(shù)式在各個(gè)方面的差異。資料收集通過查詢病歷、調(diào)查問卷及電話隨訪等方式實(shí)現(xiàn)。結(jié)果：(1)手術(shù)情況：兩組患者平均年齡、腫瘤大小和良惡性比例均無顯著差異。所有手術(shù)術(shù)中喉返神經(jīng)均連續(xù)性完好或術(shù)中神經(jīng)監(jiān)測信號(hào)均完好。術(shù)中出血無明顯差異(23.3±6.72ml vs 26.5±7.65ml,P0.05)。(2)術(shù)后情況：術(shù)后6h、12h及24h疼痛評(píng)分VAS (Visual analogue scales,視覺模糊評(píng)分)兩組無顯著差異；術(shù)后3天RSI評(píng)分(The Reflux Symptom Index,反流癥狀指數(shù)量表)無顯著差異(23.2±7.21 vs 26.1±6.80,P0.05)；術(shù)后引流量縮小胸壁分離組明顯小于傳統(tǒng)分離組(95.1±40.50ml vs 121.3±30.65ml P0.05),患者住院天數(shù)(4.0±1.32天vs 4.0±1.43天,P0.05)無顯著差異；術(shù)后3個(gè)月隨訪VHI (Voice Handicap Index,噪音障礙指數(shù))無顯著差異(21.6±4.39vs 22.7±3.42,P0.05)；術(shù)后長期隨訪感覺和外觀量表,兩組患者的頸部疼痛及不適的結(jié)果中,均在術(shù)后1-3個(gè)月內(nèi)相對于術(shù)前有明顯差異,兩組之間在長期隨訪中組間并無明顯差異；對于兩組患者的胸前區(qū)疼痛及不適的結(jié)果中,胸前區(qū)疼痛方面,縮小胸壁分離術(shù)式在術(shù)后6個(gè)月內(nèi)相對于術(shù)前有明顯差異(0.08±0.27,0.20±0.40,P=0.035),傳統(tǒng)分離方式至術(shù)后1年仍與術(shù)前相比有明顯差異(0.05±0.21,0.25±0.44,P=0.007)。兩組之間在術(shù)后3個(gè)月有明顯差異(0.35±0.48,0.79±0.63,P0.01)；胸前區(qū)不適在術(shù)后6個(gè)月內(nèi)相對于術(shù)前有明顯差異,兩組之間在術(shù)后3個(gè)月有明顯差異(0.22±0.41,0.93±0.63,P0.01),胸前區(qū)感覺異常至術(shù)后隨訪6個(gè)月內(nèi)相對于術(shù)前均有明顯差異,兩組之間在術(shù)后3個(gè)月有明顯差異(0.45±0.50,0.95±0.75,P0.01)；患者滿意度評(píng)分兩組無明顯差異(3.7±0.46 vs 3.8±0.37,P0.05)。結(jié)論：在完全腔鏡甲狀腺手術(shù)中縮小胸壁分離范圍術(shù)式與傳統(tǒng)分離范圍術(shù)式相比,在安全性方面類似,均為安全可靠的手術(shù)方式,術(shù)后患者對美容方面的滿意度相似,但創(chuàng)傷性及術(shù)后恢復(fù)有統(tǒng)計(jì)學(xué)意義,結(jié)果顯示在完全腔鏡甲狀腺手術(shù)中縮小胸壁分離范圍術(shù)式比傳統(tǒng)分離范圍術(shù)式的創(chuàng)傷小,術(shù)后不適較輕,且術(shù)后恢復(fù)較快。故縮小胸壁分離范圍的術(shù)式要優(yōu)于傳統(tǒng)分離范圍術(shù)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 鹵 7.21 vs 26.1 鹵 6.80 , P0.05 ) .
After operation , the chest wall separation group was significantly smaller than that in the conventional separation group ( 95.1 鹵 40.50 ml vs 121.3 鹵 30.65 ml P0.05 ) , and the number of days in hospital stay was 4.0 鹵 1.32 days vs 4.0 鹵 1.43 days , P0.05 ) .
There was no significant difference in the follow - up VHI at the 3 - month follow - up ( 21.6 鹵 4.39 vs 22 . 7 鹵 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 鹵 0 . 21 , 0 . 25 鹵 0 . 44 , P = 0.007 ) . There was a significant difference between the two groups ( 0 . 35 鹵 0 . 48 , 0.79 鹵 0.63 , P0.01 ) .
There was a significant difference between the two groups ( 0.22 鹵 0.41 , 0.93 鹵 0.63 , P0.01 ) . There was a significant difference between the two groups ( 0.45 鹵 0.50 , 0.95 鹵 0.75 , P0.01 ) .
There was no significant difference between the two groups ( 3.7 鹵 0.46 vs 3.8 鹵 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 .

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R653

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