3D腹腔镜辅助甲状腺癌颈侧淋巴清扫术的临床随机对照研究
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摘要
目的探究传统开放手术及2D、3D腹腔镜辅助甲状腺癌颈侧淋巴清扫术的临床价值。方法回顾性分析2015年10月至2017年12月120例进行甲状腺癌根治术患者的临床资料,依据手术方式分为开放组、2D组及3D组各40例。采用SPSS21.0统计软件包分析数据,术中术后指标、VAS评分等用(■±s)表示,两组间采用t检验,三组间采用方差齐性检验;治疗满意率和术后不良反应情况采用χ~2检验。P<0.05表示差异有统计学意义。结果 2D、3D组手术时间长于传统开放组;3D腹腔镜组术中出血量、术后24 h内引流量较2D组、传统组少(P<0.05);三组间淋巴结清扫数、术后住院时间、总出院时间差异无统计学意义(P>0.05);3D组并发症发生率7.5%,显著低于2D腹组15.0%与开放组32.5%(P<0.05);术后24 h疼痛评估及患者满意度均明显优于其他两组(P<0.05)。结论 3D腹腔镜辅助甲状腺癌颈侧淋巴清扫术临床应用安全可靠,值得进一步推广。
Objective To compare conventional open surgery and 2D and 3D assisted laparoscopic neck dissection for thyroid cancer.Methods The clinical data of 120 patients undergoing radical thyroidectomy from October 2015 to December 2017 were retrospectively analyzed.According to the surgical approach,they were divided into open group,2D group,and 3D group,each 40 cases.The SPSS 21.0statistical software package was used to analyze.The intraoperative and postoperative data and VAS scores were expressed as mean±standard deviation(■±s),and compared with t test.Satisfaction rate of treatment and postoperative adverse reactions were compared byχ~2.P<0.05 indicated that the difference was statistically significant.Results The operation time was longer in the 2D and 3D groups than in the traditional open group.The blood loss in the 3D laparoscopic group and the drainage volume within 24 hours after the operation were lower than those in the 2D group and the traditional group(P<0.05).There was no significant difference in the number of lymph node dissected and postoperative hospital stay and total discharge time among the three groups(P>0.05).The incidence of adverse reactions in the 3D group was significantly lower than that in the 2D abdominal group and the traditional group7.5%vs.15%and32.5%.The postoperative pain assessment at 24h and degree of satisfaction in 2D,3D laparoscopic group were significantly better than those in open group(P<0.05).Conclusion The clinical application of 3Dassisted laparoscopic neck dissection for thyroid cancer is safe and reliable,and is worthy of further promotion.
Objective To compare conventional open surgery and 2D and 3D assisted laparoscopic neck dissection for thyroid cancer.Methods The clinical data of 120 patients undergoing radical thyroidectomy from October 2015 to December 2017 were retrospectively analyzed.According to the surgical approach,they were divided into open group,2D group,and 3D group,each 40 cases.The SPSS 21.0statistical software package was used to analyze.The intraoperative and postoperative data and VAS scores were expressed as mean±standard deviation(■±s),and compared with t test.Satisfaction rate of treatment and postoperative adverse reactions were compared byχ~2.P<0.05 indicated that the difference was statistically significant.Results The operation time was longer in the 2D and 3D groups than in the traditional open group.The blood loss in the 3D laparoscopic group and the drainage volume within 24 hours after the operation were lower than those in the 2D group and the traditional group(P<0.05).There was no significant difference in the number of lymph node dissected and postoperative hospital stay and total discharge time among the three groups(P>0.05).The incidence of adverse reactions in the 3D group was significantly lower than that in the 2D abdominal group and the traditional group7.5%vs.15%and32.5%.The postoperative pain assessment at 24h and degree of satisfaction in 2D,3D laparoscopic group were significantly better than those in open group(P<0.05).Conclusion The clinical application of 3Dassisted laparoscopic neck dissection for thyroid cancer is safe and reliable,and is worthy of further promotion.
引文
[1] 赵永福,刘晨.甲状腺癌颈部淋巴结清扫术[J/CD].中华普外科手术学杂志:电子版,2016,10(5):378-378.
[2] 赵群仔,王勇,王平.腔镜与开放甲状腺全切除术治疗乳头状甲状腺癌的对比研究[J].中华外科杂志,2018,56(2):135-137.
[3] Siegel RL,Miller KD,Jemal A.Cancer Statistics,2017 [J].CA Cancer J Clin,2017,67(1):7-30.
[4] 兰霞斌,张浩.《2015美国甲状腺学会成人甲状腺结节与分化型甲状腺癌诊治指南》外科治疗更新解读[J].浙江医学,2016,38(5):313-316.
[5] 仉志军,杨兴旺,杨春晓,等.腹腔镜下改良淋巴结清扫术在甲状腺癌中的应用价值[J/CD].中华普外科手术学杂志:电子版,2016,10(3):228-230.
[6] 高新宝,贾高磊,田志龙,等.全乳晕入路与胸乳入路腔镜手术治疗甲状腺微灶癌的临床比较[J].中国普通外科杂志,2016,25 (11):1550-1556.
[7] 吴国洋,傅锦波,严威,等.经胸经口联合入路腔镜下行甲状腺癌中央区淋巴结清扫术[J].中华外科杂志,2016,54(4):297-298.
[8] Tavarelli M,Russo M,Terranova R,et al.Familial non-medullarythy-roid cancer represents an independent risk factor for increased cancer aggressiveness:a retrospective analysis of 74 families [J].Front Endocrinol(Lausanne),2015,6:117-117.
[9] 陈之显,刘明,李广恩,等.完全腔镜下甲状腺癌改良颈淋巴结清扫术的临床应用价值[J].腹腔镜外科杂志,2016,21(4):263-266.
[10] 姚京,费阳,田文.全腔镜下胸乳入路和传统颈前开放入路行甲状腺全切除术对甲状腺乳头状癌术后甲状旁腺功能的影响[J].中国普外基础与临床杂志,2016,23(9):1097-1100.
[11] 傅锦波,罗晔哲,洪晓泉,等.经胸经口联合入路腔镜甲状腺癌切除术26例[J].中华普通外科杂志,2017,32(3):191-193.
[12] 王平,燕海潮.腔镜甲状腺手术系列报道之手术空间的建立与维持[J].中国普通外科杂志,2016,25(11):1531-1535.
[13] 陈彦辰,林晓杰,陈红燕,等.纳米碳注射在3D腔镜甲状腺癌手术中的应用[J].中国内镜杂志,2017,23(10):37-41.
[14] 柳学文,李强,陈飞,等.3D腔镜在甲状腺全切及中央区淋巴结清扫术中的临床效果[J].南方医科大学学报,2017 ,37 (6) :842-846.
[15] Agrusa A,di Buono G,Chianetta D,et al.Three-dimensional (3D) versus two-dimensional (2D) laparoscopic adrenalectomy:A case control study[J].Int J Surg,2016,28(Suppl 1):S114-S117.
[16] Velayutham V,Fuks D,Nomi T,et al.3D visualization reduces operating time when compared to high-definition 2D in laparoscopic liver resection:a case-matched study[J].Surg Endosc,2016,30(1):147-153.
[2] 赵群仔,王勇,王平.腔镜与开放甲状腺全切除术治疗乳头状甲状腺癌的对比研究[J].中华外科杂志,2018,56(2):135-137.
[3] Siegel RL,Miller KD,Jemal A.Cancer Statistics,2017 [J].CA Cancer J Clin,2017,67(1):7-30.
[4] 兰霞斌,张浩.《2015美国甲状腺学会成人甲状腺结节与分化型甲状腺癌诊治指南》外科治疗更新解读[J].浙江医学,2016,38(5):313-316.
[5] 仉志军,杨兴旺,杨春晓,等.腹腔镜下改良淋巴结清扫术在甲状腺癌中的应用价值[J/CD].中华普外科手术学杂志:电子版,2016,10(3):228-230.
[6] 高新宝,贾高磊,田志龙,等.全乳晕入路与胸乳入路腔镜手术治疗甲状腺微灶癌的临床比较[J].中国普通外科杂志,2016,25 (11):1550-1556.
[7] 吴国洋,傅锦波,严威,等.经胸经口联合入路腔镜下行甲状腺癌中央区淋巴结清扫术[J].中华外科杂志,2016,54(4):297-298.
[8] Tavarelli M,Russo M,Terranova R,et al.Familial non-medullarythy-roid cancer represents an independent risk factor for increased cancer aggressiveness:a retrospective analysis of 74 families [J].Front Endocrinol(Lausanne),2015,6:117-117.
[9] 陈之显,刘明,李广恩,等.完全腔镜下甲状腺癌改良颈淋巴结清扫术的临床应用价值[J].腹腔镜外科杂志,2016,21(4):263-266.
[10] 姚京,费阳,田文.全腔镜下胸乳入路和传统颈前开放入路行甲状腺全切除术对甲状腺乳头状癌术后甲状旁腺功能的影响[J].中国普外基础与临床杂志,2016,23(9):1097-1100.
[11] 傅锦波,罗晔哲,洪晓泉,等.经胸经口联合入路腔镜甲状腺癌切除术26例[J].中华普通外科杂志,2017,32(3):191-193.
[12] 王平,燕海潮.腔镜甲状腺手术系列报道之手术空间的建立与维持[J].中国普通外科杂志,2016,25(11):1531-1535.
[13] 陈彦辰,林晓杰,陈红燕,等.纳米碳注射在3D腔镜甲状腺癌手术中的应用[J].中国内镜杂志,2017,23(10):37-41.
[14] 柳学文,李强,陈飞,等.3D腔镜在甲状腺全切及中央区淋巴结清扫术中的临床效果[J].南方医科大学学报,2017 ,37 (6) :842-846.
[15] Agrusa A,di Buono G,Chianetta D,et al.Three-dimensional (3D) versus two-dimensional (2D) laparoscopic adrenalectomy:A case control study[J].Int J Surg,2016,28(Suppl 1):S114-S117.
[16] Velayutham V,Fuks D,Nomi T,et al.3D visualization reduces operating time when compared to high-definition 2D in laparoscopic liver resection:a case-matched study[J].Surg Endosc,2016,30(1):147-153.