CAJ | 학술논문

目的：比较改良Miccoli术式与直视下小切口行甲状腺双侧次全切除术治疗Graves病的效果。方法将我院2012年1月～2013年11月107例Graves病按患者自愿原则分为：A组改良Miccoli术式（n＝64），B组直视下小切口（n＝43）。对2组的切口长度、出血量、手术时间、并发症、术后疼痛、术后住院时间、住院费用、病人对切口满意度等进行比较。结果107例Graves病均顺利完成甲状腺双侧次全切除术。 A组切口长（3．07±0．10）cm，明显小于B组（3．61±0．30）cm（t＝－13．363，P＝0．000）；A组出血量（29．4±6．1）ml，明显少于B组（95．3±15．6）ml（t＝－30．551，P＝0．000）；A组手术时间（83．2±7．5）min，明显短于B组（109．5±15．9）min（t＝－11．485，P＝0．000）。术后病理均证实为Graves病。 A组VAS评分（1．8±0．7）分，明显低于B组（2．8±0．6）分（t＝－7．663，P＝0．000）；A组住院时间（3．9±1．0）d，明显短于B组（4．8±0．7）d （t＝－5．116，P＝0．000）；A组住院费用（8892．4±297．6）元，明显高于B组（7283．5±150．9）元（t＝32．704，P＝0．000）。2组均无甲亢危象、永久性声嘶及肢体抽搐等严重并发症。 B组发生一过性声嘶和抽搐各1例，均经治疗后恢复；A组发生皮缘损伤3例，B组14例；2组并发症发生率有统计学差异（χ2＝18．627，P＝0．000）。随访情况：随访3～6个月，A组11例出现甲状腺功能减退，B组8例，无统计学差异（χ2＝0．035，P＝0．851）；2组各有1例复发，均为年轻患者，无统计学差异（χ2＝0．000， P＝1．000）；切口美观满意度调查评分A组（8．2±0．8）分，明显高于B组（7．2±1．1）分（t＝5．443，P＝0．000）。结论改良Miccoli术式与直视下小切口行双侧次全切除治疗Graves病的疗效无明显差异。改良Miccoli术式安全性和切口美观效果更优，直视下小切口手术不使用腔镜，节省了手术费用。目的：比較改良Miccoli術式與直視下小切口行甲狀腺雙側次全切除術治療Graves病的效果。方法將我院2012年1月～2013年11月107例Graves病按患者自願原則分為：A組改良Miccoli術式（n＝64），B組直視下小切口（n＝43）。對2組的切口長度、齣血量、手術時間、併髮癥、術後疼痛、術後住院時間、住院費用、病人對切口滿意度等進行比較。結果107例Graves病均順利完成甲狀腺雙側次全切除術。 A組切口長（3．07±0．10）cm，明顯小于B組（3．61±0．30）cm（t＝－13．363，P＝0．000）；A組齣血量（29．4±6．1）ml，明顯少于B組（95．3±15．6）ml（t＝－30．551，P＝0．000）；A組手術時間（83．2±7．5）min，明顯短于B組（109．5±15．9）min（t＝－11．485，P＝0．000）。術後病理均證實為Graves病。 A組VAS評分（1．8±0．7）分，明顯低于B組（2．8±0．6）分（t＝－7．663，P＝0．000）；A組住院時間（3．9±1．0）d，明顯短于B組（4．8±0．7）d （t＝－5．116，P＝0．000）；A組住院費用（8892．4±297．6）元，明顯高于B組（7283．5±150．9）元（t＝32．704，P＝0．000）。2組均無甲亢危象、永久性聲嘶及肢體抽搐等嚴重併髮癥。 B組髮生一過性聲嘶和抽搐各1例，均經治療後恢複；A組髮生皮緣損傷3例，B組14例；2組併髮癥髮生率有統計學差異（χ2＝18．627，P＝0．000）。隨訪情況：隨訪3～6箇月，A組11例齣現甲狀腺功能減退，B組8例，無統計學差異（χ2＝0．035，P＝0．851）；2組各有1例複髮，均為年輕患者，無統計學差異（χ2＝0．000， P＝1．000）；切口美觀滿意度調查評分A組（8．2±0．8）分，明顯高于B組（7．2±1．1）分（t＝5．443，P＝0．000）。結論改良Miccoli術式與直視下小切口行雙側次全切除治療Graves病的療效無明顯差異。改良Miccoli術式安全性和切口美觀效果更優，直視下小切口手術不使用腔鏡，節省瞭手術費用。
목적：비교개량Miccoli술식여직시하소절구행갑상선쌍측차전절제술치료Graves병적효과。방법장아원2012년1월～2013년11월107례Graves병안환자자원원칙분위：A조개량Miccoli술식（n＝64），B조직시하소절구（n＝43）。대2조적절구장도、출혈량、수술시간、병발증、술후동통、술후주원시간、주원비용、병인대절구만의도등진행비교。결과107례Graves병균순리완성갑상선쌍측차전절제술。 A조절구장（3．07±0．10）cm，명현소우B조（3．61±0．30）cm（t＝－13．363，P＝0．000）；A조출혈량（29．4±6．1）ml，명현소우B조（95．3±15．6）ml（t＝－30．551，P＝0．000）；A조수술시간（83．2±7．5）min，명현단우B조（109．5±15．9）min（t＝－11．485，P＝0．000）。술후병리균증실위Graves병。 A조VAS평분（1．8±0．7）분，명현저우B조（2．8±0．6）분（t＝－7．663，P＝0．000）；A조주원시간（3．9±1．0）d，명현단우B조（4．8±0．7）d （t＝－5．116，P＝0．000）；A조주원비용（8892．4±297．6）원，명현고우B조（7283．5±150．9）원（t＝32．704，P＝0．000）。2조균무갑항위상、영구성성시급지체추휵등엄중병발증。 B조발생일과성성시화추휵각1례，균경치료후회복；A조발생피연손상3례，B조14례；2조병발증발생솔유통계학차이（χ2＝18．627，P＝0．000）。수방정황：수방3～6개월，A조11례출현갑상선공능감퇴，B조8례，무통계학차이（χ2＝0．035，P＝0．851）；2조각유1례복발，균위년경환자，무통계학차이（χ2＝0．000， P＝1．000）；절구미관만의도조사평분A조（8．2±0．8）분，명현고우B조（7．2±1．1）분（t＝5．443，P＝0．000）。결론개량Miccoli술식여직시하소절구행쌍측차전절제치료Graves병적료효무명현차이。개량Miccoli술식안전성화절구미관효과경우，직시하소절구수술불사용강경，절성료수술비용。
Objective To compare treatment effects between improved Miccoli surgery and small incision bilateral subtotal thyroidectomy under direct vision in the treatment of Graves disease. Methods According to patients’ will, 107 patients with Graves disease from January 2012 to November 2013 in this hospital were divided into two groups, receiving either improved Miccoli surgery (group A, n=64) or small incision bilateral subtotal thyroidectomy under direct vision (group B, n=43).A comparative analysis between the two groups was made on incision length, blood loss, operation time, complications, postoperative pain, hospital stay, hospital costs, and patient satisfaction. Results All the patients successfully underwent bilateral subtotal thyroidectomy.The incision length of the group A (3.07 ±0.10) cm was significantly shorter than that of the group B[(3.61 ±0.30) cm, t=-13.363, P=0.000].The blood loss of the group A (29.4 ±6.1) ml was significantly less than that of the group B [(95.3 ±15.6) ml, t=-30.551, P=0.000].The operation time of the group A (83.2 ±7.5) min was significantly less than that of the group B [(109.5 ±15.9) min, t=-11.485, P=0.000].Postoperatively, diagnoses were confirmed by pathological examinations as Graves disease in all the patients.The VAS of the group A (1.8 ±0.7) points was significantly lower than that of the group B [(2.8 ±0.6) points, t=-7.663, P=0.000).The length of hospitalization of the group A (3.9 ±1.0) d was significantly shorter than that of the group B [(4.8 ±0.7) d, t=-5.116, P=0.000].The hospitalization charges of the group A (8892.4 ±297.6) yuan was significantly higher than that of the group B [(7283.5 ±150.9) yuan, t=32.704, P=0.000].There were no serious complications. The group B had one case of transient hoarseness and one case of convulsions, both of which recovered after treatment.There were 3 cases of skin flap damage in the group A and 14 cases in the group B.There was statistically significant difference in the complication rate(χ2 =18.627,P=0.000).Follow-up observations for 3-6 months found both groups experienced one case of recurrence (χ2 =0.000, P=1.000).The group A had 11 cases of subclinical hypothyroidism after surgery, and the group B had 8 cases (χ2 =0.035, P=0.851).The score of satisfaction with incision of the group A (8.2 ±0.8) points was significantly higher than that of the group B [(7.2 ±1.1) points, t =5.433, P=0.000]. Conclusions The improved Miccoli surgery and direct small incision bilateral subtotal thyroidectomy for the treatment of Graves disease are both feasible.There is no significant differences in treatment effects.The improved Miccoli surgery is superior in the safety, minimal invasion, and cosmetic outcomes, but the small incision under direct vision has lower cost of surgery.