[1]冯剑平 唐诗彬** 梁智强 叶剑.腔镜Dunhill术式治疗甲状腺功能亢进的临床应用[J].中国微创外科杂志,2020,01(4):341-375.
 Feng Jianping,Tang Shibin,Liang Zhiqiang,et al.Clinical Application of Endoscopic Dunhill Operation in the Treatment of Hyperthyroidism[J].Chinese Journal of Minimally Invasive Surgery,2020,01(4):341-375.
点击复制

腔镜Dunhill术式治疗甲状腺功能亢进的临床应用()
分享到:

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2020年4期
页码:
341-375
栏目:
临床研究
出版日期:
2020-04-25

文章信息/Info

Title:
Clinical Application of Endoscopic Dunhill Operation in the Treatment of Hyperthyroidism
作者:
冯剑平 唐诗彬** 梁智强 叶剑
(南方医科大学顺德医院甲状腺乳腺血管外科,佛山528308)
Author(s):
Feng Jianping Tang Shibin Liang Zhiqiang et al.
Department of Thyroid,Breast and Vascular Surgery, Shunde Hospital, Southern Medical University, Foshan 528308, China
关键词:
腔镜甲状腺功能亢进症甲状腺叶切除术
Keywords:
EndoscopyHyperthyroidismThyroidectomy
文献标志码:
A
摘要:
目的探讨胸乳入路腔镜Dunhill术式治疗甲状腺功能亢进(甲亢)的效果。方法回顾分析我科2010年1月~2018年12月采用Dunhill术式治疗41例甲亢,根据患者意愿选择术式,腔镜Dunhill术式18例(腔镜组),开放Dunhill术式23例(开放组)。比较2组手术时间、术中出血量、术后24 h引流量、住院时间、住院费用、术后并发症、术后1个月甲状腺功能等指标。结果41例手术均成功完成,腔镜组与开放组住院时间、术后1个月甲状腺功能(TSH、FT3、FT4)及并发症比较,差异无统计学意义(P>0.05),但腔镜组住院费用明显高于开放组[(18 349.22±938.07)元 vs. (15 929.13±875.45)元,t=8.514,P=0.000],手术时间明显长于开放组[(171.3±5.2) min vs. (163.5±7.9) min,t=3.637,P=0.001],术中出血量[(28.7±9.7) ml vs. (37.3±7.8) ml,t=-3.146,P=0.003]、术后24 h引流量[(44.1±10.8) ml vs. (58.0±15.0) ml,t=-3.317,P=0.002]明显少于开放组。结论胸乳入路腔镜Dunhill术式治疗甲亢是安全、有效、可行的,有一定的美容效果的方法。
Abstract:
ObjectiveTo study the efficacy of endoscopic Dunhill operation in the treatment of hyperthyroidism. MethodsA total of 41 patients with hyperthyroidism in our hospital from January 2010 to December 2018 were divided into the endoscopic surgery group (n=18) and the open surgery group (n=23) according to the willingness of the patients. Patients in the endoscopic surgery group underwent endoscopic thyroidectomy by Dunhill approach, while patients in the open surgery group underwent open thyroidectomy by Dunhill approach. The operation time, intraoperative bleeding volume, postoperative 24hour drainage volume, hospitalization time, hospitalization cost, postoperative complications and thyroid function were compared between the two groups.ResultsThe operations were successful in all the 41 patients. There were no statistically significant differences between the two groups in hospital stays, hormone levels (TSH, FT3, FT4) in the first month after surgery and complications (P>0.05). The cost of hospitalization in the endoscopic group was significantly higher than that in the open group [(18 349.22±938.07) yuan vs. (15 92913±875.45) yuan, t=8.514, P=0.000]. The operation time was significantly longer than that in the open group [(1713±5.2) min vs. (163.5±7.9) min, t=3.637, P=0.001]. The amount of bleeding during the operation [(28.7±9.7) ml vs. (37.3±7.8) ml, t=-3.146, P=0.003] and the volume of postoperative 24hour drainage [(44.1±10.8) ml vs. (58.0±15.0) ml, t=-3.317, P=0.002] were significantly less than those in the open group.ConclusionEndoscopic Dunhill operation in the treatment of hyperthyroidism is a safe, effective and feasible method with good cosmetic results.

参考文献/References:

[1]Sancho JJ, Prieto R, Duenas JP, et al. A randomized trial of hemithyroidectomy versus Dunhill for the surgical management of asymmetrical multinodular goiter. Ann Surg,2012,256(5):846-852.
[2]Gagner M. Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg,1996,83(6):875.
[3]Huscher CS, Chiodini S, Napolitano C, et al. Endoscopic right thyroid lobectomy. Surg Endosc,1997,11(8):877.
[4]Smithson M, Asban A, Miller J, et al. Considerations for thyroidectomy as treatment for Graves disease. Clin Med Insights Endocrinol Diabetes,2019,12:1-5.
[5]黎东伟,李君久,熊秋华,等.腔镜甲状腺次全切除术在原发性甲状腺功能亢进外科治疗中的应用.中国微创外科杂志,2016,16(8):749-751.
[6]梅锋,邱凌,徐伟宏.经乳晕气管前入路在腔镜甲状腺手术中的应用.中国微创外科杂志,2013,13(6):493-495.
[7]Lale A, z A, Akcan AC, et al. Determination of risk factors causing hypocalcaemia after thyroid surgery. Asian J Surg,2019,42(9):883-889.
[8]Qurat C, Germain N, Dumollard JM, et al. Surgical management of hyperthyroidism. Eur Ann Otorhinolaryngol Head Neck Dis,2015,132(2):63-66.
[9]李志辉,朱精强,魏涛,等.甲状旁腺在人体中的分布特点及临床意义(附50例解剖研究报告).中国普外基础与临床杂志, 2008,15(5):311-313,317.
[10]赵雪云,李远平,张英毅,等.纳米碳甲状旁腺负显影技术在甲状腺癌术中的应用.中国药物经济学,2018,13(8):41-43.
[11]Zhang C, Li X, Zhang Z, et al. The potential role of carbon nanoparticlesassisted biopsy for sentinel lymph nodes of incidental thyroid carcinoma. Gland Surg,2019,8(4):370-377.
[12]闫斌斌,贺晨宇,贺建业,等.甲状腺手术中手术刀和超声刀联合应用解剖Berry韧带的安全性和可行性:前瞻性随机对照研究.中国微创外科杂志,2019,19(4):298-302.
[13]王平,燕海潮.腔镜技术在复杂甲状腺手术治疗的应用及体会.医学与哲学,2015,36(20):13-15.
[14]Wang P, Zhao QZ. Endoscopic thyroid surgery: the past, the present, and the future. Zhonghua Wai Ke Za Zhi,2016,54(11):815-818.
[15]Guo Y, Qu R, Huo J, et al. Technique for endoscopic thyroidectomy with selective lateral neck dissection via a chestbreast approach. Surg Endosc,2019,33(4):1334-1341.
[16]Tam AA, Ozdemir D, Alkan A, et al. Toxic nodular goiter and thyroid cancer: Is hyperthyroidism protective against thyroid cancer? Surgery,2019,166(3):356-361.
[17]Jarhult J, Andersson PO, Duncker L. Alternating from subtotal thyroid resection to total thyroidectomy in the treatment of Graves’ disease prevents recurrences but increases the frequency of permanent hypoparathyroidism. Langenbecks Arch Surg,2012,397(3):407-412.
[18]Cipolla C, Graceffa G, Calamia S, et al. The value of total thyroidectomy as the definitive treatment for Graves’ disease: A single centre experience of 594 cases. J Clin Transl Endocrinol,2019,16:100183.

备注/Memo

备注/Memo:
基金项目:广东省医学科学技术研究基金项目(B2016051)**通讯作者,Email:tangshibin1966@qq.com
更新日期/Last Update: 2020-07-14