CAJ | 학술논문

目的：比较颈部入路与颈外入路腔镜甲状腺手术的效果。方法2012年10月～2013年12月，采用完全随机设计方法（随机数字表法），对44例符合适应证的甲状腺肿瘤分别进行改良Miccoli（A组，n＝20）和经乳晕入路（B组，n＝24）腔镜甲状腺肿块切除手术，比较2组的手术时间、术中出血量、术后24小时疼痛、术后引流量、术后住院时间、住院费用、并发症及美容满意度。结果与B组相比，A组手术时间短[（77．9±28．3） min vs．（97．9±30．0） min，t ＝-2．259，P＝0.029]，术中出血量少[（15．9±8．7） ml vs．（29．5±16．1） ml，t＝-3．384，P＝0．002]，术后24小时疼痛轻（不痛、可以忍受、难以忍受的例数分别为15、5、0 vs．7、15、2，Z＝-3．066，P＝0．002），术后引流量少[（31．7±10．3）ml vs．（57．0±14．6）ml， t＝-6．511，P＝0．000]，但美容满意度低（非常不满意、不满意、满意、较为满意、非常满意的例数分别为1、4、5、6、4 vs．0、1、4、5、14，Z＝-2．723，P＝0．006），术后住院时间和住院费用2组差异无显著性（P＞0．05）。 A组1例短暂声音嘶哑，B组1例低钙性双手颤动，予对症处理后均于术后1个月内恢复，无永久性喉返神经损伤、甲状旁腺损伤及其他并发症。结论颈部入路腔镜甲状腺手术创伤小，兼顾美容效果，颈部只见小瘢痕；颈外入路腔镜甲状腺手术相对创伤大，但美容满意度高，颈部未见瘢痕，能减少患者心理创伤，对美容要求较高的患者可选择性使用经乳晕入路腔镜甲状腺手术。
목적：비교경부입로여경외입로강경갑상선수술적효과。방법2012년10월～2013년12월，채용완전수궤설계방법（수궤수자표법），대44례부합괄응증적갑상선종류분별진행개량Miccoli（A조，n＝20）화경유훈입로（B조，n＝24）강경갑상선종괴절제수술，비교2조적수술시간、술중출혈량、술후24소시동통、술후인류량、술후주원시간、주원비용、병발증급미용만의도。결과여B조상비，A조수술시간단[（77．9±28．3） min vs．（97．9±30．0） min，t ＝-2．259，P＝0.029]，술중출혈량소[（15．9±8．7） ml vs．（29．5±16．1） ml，t＝-3．384，P＝0．002]，술후24소시동통경（불통、가이인수、난이인수적례수분별위15、5、0 vs．7、15、2，Z＝-3．066，P＝0．002），술후인류량소[（31．7±10．3）ml vs．（57．0±14．6）ml， t＝-6．511，P＝0．000]，단미용만의도저（비상불만의、불만의、만의、교위만의、비상만의적례수분별위1、4、5、6、4 vs．0、1、4、5、14，Z＝-2．723，P＝0．006），술후주원시간화주원비용2조차이무현저성（P＞0．05）。 A조1례단잠성음시아，B조1례저개성쌍수전동，여대증처리후균우술후1개월내회복，무영구성후반신경손상、갑상방선손상급기타병발증。결론경부입로강경갑상선수술창상소，겸고미용효과，경부지견소반흔；경외입로강경갑상선수술상대창상대，단미용만의도고，경부미견반흔，능감소환자심리창상，대미용요구교고적환자가선택성사용경유훈입로강경갑상선수술。
Objective To compare the therapeutic effects between cervical and extra-cervical surgical approaches for endoscopic thyroidectomy . Methods From October 2012 to December 2013, forty-four thyroid goiter patients were divided into two groups randomly .Group A underwent modified Miccoli endoscopic thyroidectomy ( n =20 ) and group B underwent endoscopic thyroidectomy via breast areola approach ( n=24 ) .The operative time , intraoperative blood loss , pain in 24 hours postoperatively , drainage volume , postoperative hospital stay , hospital cost , complication and cosmetic results between the two groups were compared . Results Compared with group B, group A had shorter operative time [(77.9 ±28.3) min vs.(97.9 ±30.0) min, t=-2.259, P=0.029], less intraoperative blood loss [(15.9 ±8.7) ml vs.(29.5 ±16.1) ml, t=-3.384, P=0.002], less pain in 24 hours postoperatively ( no pain, endurable pain , intolerable pain in group A and B were 15, 5, 0 and 7, 15, 2 cases respectively , Z=-3.066, P=0.002), less postoperative drainage volume [(31.7 ±10.3) ml vs.(57.0 ±14.6) ml, t=-6.511, P=0.000], but poorer cosmetic results (very dissatisfied, not satisfied, satisfied, comparatively satisfied, and very satisfied in group A and B were 1, 4, 5, 6, 4 and 0, 1, 4, 5, 14 cases respectively, Z=-2.723, P=0.006).There was no significant difference in postoperative hospital stay and hospital cost between the two groups (P>0.05).One case suffered transient hoarseness in group A and one case had trembling hand due to low calcium level in group B and both of them recovered 1 month after symptomatic treatment .No permanent recurrent laryngeal nerve injury , parathyroid injury or other complications occurred in both groups . Conclusions Cervical approach is minimally invasive and leads to good cosmetic results while extra-cervical approach causes bigger trauma but leads to better cosmetic results.Patients with high cosmetic reguest may choose endoscopic thyroidectomy via breast areola approach .