广西医学

目的探讨经锁骨上窝斜切口入路在双侧甲状腺手术中的应用效果。方法回顾性分析94例施行双侧甲状腺手术治疗患者的临床资料，根据手术入路将患者分为斜切口组（采用经锁骨上窝斜切口入路，n=32）、正中切口组（采用经颈白线切口入路，n=32）和腔镜乳晕组（采用腔镜下全乳晕切口入路，n=30）。分别采用疼痛视觉模拟量表（VAS）和数字评分系统（NSS）量表评估患者术后疼痛情况和切口满意度。比较3组患者的围手术期指标（手术时间、术中出血量、术后24 h引流量及术后拔管时间）、术后病理结果、术后并发症发生情况、术后主观不适感觉（切口疼痛感、手术区域皮肤麻木感、吞咽不适感）情况，以及术后疼痛VAS评分和NSS量表评分。结果斜切口组、正中切口组、腔镜乳晕组的手术时间依次增加（P<0.05）；斜切口组术中出血量及术后24 h引流量少于正中切口组和腔镜乳晕组（P<0.05）；3组患者术后拔管时间、病灶最大直径、中央区淋巴结清扫数目和淋巴结转移率比较，差异无统计学意义（P>0.05）；腔镜乳晕组的术后24 h疼痛VAS评分高于斜切口组和正中切口组（P<0.05），3组患者术后并发症发生率、术后主观不适感受发生率和术后48 h疼痛VAS评分的差异无统计学意义（P>0.05）；斜切口组、腔镜乳晕组术后NSS量表评分高于正中切口组（P<0.05）。结论经锁骨上窝斜切口入路在双侧甲状腺手术中的应用效果良好，相较于经颈白线切口入路与腔镜下全乳晕切口入路，其手术时间更短，术中出血量和术后引流量更少，术后疼痛较轻，患者对切口的满意度较高。

Objective To explore the application effect of oblique incision approach via supraclavicular fossa in bilateral thyroid surgery. Methods The clinical data of 94 patients who underwent bilateral thyroid surgery were retrospectively analyzed, and patients were divided into oblique incision group (oblique incision approach via supraclavicular fossa, n=32), median incision group (incision approach via cervical white line, n=32), or endoscopic areola group (incision approach via endoscopic whole areola, n=30) according to the surgical approaches. Pain Visual Analogue Scale (VAS) and Numerical Scoring System (NSS) scale were employed to evaluate postoperative pain and incision satisfaction of patients, respectively. Perioperative indices in terms of operation duration, intraoperative bleeding volume, 24⁃hour postoperative drainage volume, and postoperative extubation time, postoperative pathologic findings, postoperative occurrence states of complications, postoperative subjective discomfort (incision pain, skin numbness in surgical area, swallowing discomfort), and postoperative pain VAS score and NSS scale score were compared between patients of the three groups. Results The operation duration was increased successively in the oblique incision group, median incision group and the endoscopic areola group (P<0.05). The oblique incision group exhibited less intraoperative bleeding volume and 24⁃hour postoperative drainage volume as compared with the median incision and endoscopic areola groups (P<0.05). There was no statistically significant difference in postoperative extubation time, the maximum diameter of lesion, number of central lymph nodes dissection, and metastasis rate of lymph nodes between the three groups (P>0.05). VAS score for pain 24 hours after operation was higher in the endoscopic areola group than in the oblique incision and the median incision groups (P<0.05). There was no statistically significant difference in postoperative incidence rate of complications, postoperative incidence rate of subjective discomfort, and 48⁃hour postoperative VAS score for pain between the three groups (P>0.05). Postoperative NSS scale score was higher in the oblique incision group and the endoscopic areola group than in the median incision group (P<0.05). Conclusion Application effect of oblique incision approach via supraclavicular fossa in bilateral thyroid surgery is favorable. Compared with incision approaches via cervical white line and endoscopic whole areola, it exhibits shorter operation duration, less intraoperative bleeding volume and postoperative drainage volume, and favorably relieved postoperative pain, as well as relatively high satisfaction for incision in patients.

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