CAJ | 학술논문

目的：探讨改良 Miccoli 术式甲状腺双侧次全切除术治疗 Graves 病的临床效果，为临床诊治提供参考。方法选择 Graves 病患者80例，根据手术方式分为对照组与观察组，对照组44例行直视下小切口甲状腺双侧次全切除术治疗，观察组36例患者行改良 Miccoli 术式。比较两组手术成功率、手术指标、围术期临床指标、术后视觉模拟疼痛（VAS）评分、切口满意度等指标。结果两组手术均顺利进行，成功率均为100.00％。观察组切口长度、手术出血量、手术时间分别为（3．04±0．64）cm、（32．25±3．29）mL、（81．19±6.68）min，均明显优于对照组，差异均有统计学意义（t ＝5．214，P ＝0．004；t ＝14．514，P ＝0．000；t ＝6．514，P ＝0.001）；观察组 VAS 评分、住院时间、并发症发生率分别为（1．93±0．43）分、（3．82±0．79）d、5．26％，均明显优于对照组，差异均有统计学意义（t ＝5．697，P ＝0．003；t ＝4．654，P ＝0．009；χ2＝11．214，P ＝0．000）；观察组住院费用为（9043．65±565．76）元，明显高于对照组，差异有统计学意义（P ＜0．05）；观察组切口评分为（8.35±2．15）分，明显高于对照组，差异有统计学意义（t ＝8．364，P ＝0．001）；两组随访期间甲亢复发、甲状腺功能减退发生率差异无统计意义（χ2＝0．568，P ＝0．311；χ2＝0．604，P ＝0．294）。结论改良 Miccoli 术式与直视下小切口甲状腺双侧次全切除术治疗 Graves 病临床效果相近，改良 Miccoli 术式创伤更小，切口满意度更高，直视下小切口术式治疗成本更低，临床应酌情选用术式。
목적：탐토개량 Miccoli 술식갑상선쌍측차전절제술치료 Graves 병적림상효과，위림상진치제공삼고。방법선택 Graves 병환자80례，근거수술방식분위대조조여관찰조，대조조44례행직시하소절구갑상선쌍측차전절제술치료，관찰조36례환자행개량 Miccoli 술식。비교량조수술성공솔、수술지표、위술기림상지표、술후시각모의동통（VAS）평분、절구만의도등지표。결과량조수술균순리진행，성공솔균위100.00％。관찰조절구장도、수술출혈량、수술시간분별위（3．04±0．64）cm、（32．25±3．29）mL、（81．19±6.68）min，균명현우우대조조，차이균유통계학의의（t ＝5．214，P ＝0．004；t ＝14．514，P ＝0．000；t ＝6．514，P ＝0.001）；관찰조 VAS 평분、주원시간、병발증발생솔분별위（1．93±0．43）분、（3．82±0．79）d、5．26％，균명현우우대조조，차이균유통계학의의（t ＝5．697，P ＝0．003；t ＝4．654，P ＝0．009；χ2＝11．214，P ＝0．000）；관찰조주원비용위（9043．65±565．76）원，명현고우대조조，차이유통계학의의（P ＜0．05）；관찰조절구평분위（8.35±2．15）분，명현고우대조조，차이유통계학의의（t ＝8．364，P ＝0．001）；량조수방기간갑항복발、갑상선공능감퇴발생솔차이무통계의의（χ2＝0．568，P ＝0．311；χ2＝0．604，P ＝0．294）。결론개량 Miccoli 술식여직시하소절구갑상선쌍측차전절제술치료 Graves 병림상효과상근，개량 Miccoli 술식창상경소，절구만의도경고，직시하소절구술식치료성본경저，림상응작정선용술식。
Objective To investigate clinical effect of Miccoli surgical thyroid bilateral subtotal resection for Graves disease,to provide a reference for clinical treatment.Methods 80 patients with Graves disease were selected, they were divided into the observation group and the control group according to the surgical approach.44 patients in control group were taken small incision under direct vision routine bilateral subtotal thyroid treatment,36 patients in the observation group took Miccoli surgical.Surgical success rate,surgical index were compared between two groups. Results The patients of the two groups were operated smoothly,the success rate was 100.00% in the observation group,the incision length,blood loss,operative time were (3.04 ±0.64)cm,(32.25 ±3.29)mL,(81.19 ±6.68)min respectively,which were significantly less than those of the control group,the differences were statistically significant (t =5.214,P =0.004;t =14.514,P =0.000;t =6.514,P =0.001).The VAS score,length of stay,incidence rate of complication in the observation group were (1.93 ±0.43),(3.82 ±0.79)d,5.26%,which were significantly better than those in the control group,the differences were statistically significant (t =5.697,P =0.003;t =4.654,P =0.009;χ2 =11.214,P =0.000).The hospitalization cost of the observation group was (9 043.65 ±565.76)Yuan, which was significantly higher than the control group,the difference was statistically significant (P <0.05).The cut rating of the observation group was (8.35 ±2.15)points,which was significantly higher than the control group,the difference was statistically significant (t =8.364,P =0.001 ).The hyperthyroidism relapse during follow -up,the incidence of thyroid dysfunction between the two groups had no significant difference (χ2 =0.568,P =0.311;χ2 =0.604,P =0.294).Conclusion Miccoli improved surgical incision and under direct vision thyroid bilateral subtotal resection both have similar clinical effects for Graves disease,Miccoli surgery has smaller trauma,more satisfaction incision,but under direct vision small incisions has lower treatment costs.