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缩小胸壁分离范围的腔镜甲状腺手术与开放手术术后疼痛对比分析

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缩小胸壁分离范围的腔镜甲状腺手术与开放手术术后疼痛对比分析

作者:徐飞等

来源:《中国医学创新》2014年第14期

【摘要】目的:比较缩小胸壁分离范围的腔镜甲状腺手术与开放手术术后的疼痛程度。

方法:70例甲状腺疾病患者根据所选手术方式不同分为腔镜组35例(腔镜组采用充分利用Trocar长度,经各切口建立隧道,会师于胸壁上部空间以缩小胸壁分离范围的方法)和开放组35例,用视觉模拟评分法(VAS)评判两组术后1、4 h及1、2、3、5、10 d的疼痛程度,记录两组术后24 h内需要镇痛的患者例数,并行统计分析。结果:两组术后4 h和术后5 d的疼痛程度比较差异无统计学意义(P>0.05);腔镜组术后1 h,术后1、2、3 d的疼痛程度较开放组轻,差异有统计学意义(P0.05)。结论:尽管缩小胸壁分离范围的腔镜甲状腺手术的皮下剥离面积仍大于开放手术,但其术后疼痛程度却较开放组轻,且没有导致术后需要止痛患者例数的增加。

【关键词】腔镜;甲状腺手术;术后疼痛

【Abstract】 Objective: To compare the postoperative pain caused by open thyroidectomy and improving-chest-separation-method endoscopic thyroidectomy. Method: 70 patients with thyroid diseases were divided into two groups according to the different ways of operation. The endoscopic group with 35 patients took full advantage of the length of Trocar when separating the skin of chest to create tunnels via each incision to meet at the upper chest space. The conventional group with 35 patients were operated on by conventional open thyroidectomy. The degree of pain at 1,4 hour,

1, 2, 3, 5, and 10 days postoperatively were measured by Visual Analogue Scale(VAS),and the number of patients who need analgesia in two groups within 24 hours after surgery were count and analyzed. Result: The postoperative pain after 4 hour and 5 days between two groups were not significantly different (P>0.05). However, the pain scores in the endoscopic group at 1 h,1,2,and 3 days after surgery were significantly lower than that in the conventional open group

(P0.05). Conclusion: Even though the endoscopic thyroidectomy using the improving chest separation methods requires a more extensive subcutaneous dissection than conventional open thyroidectomy, the endoscopic thyroidectomy using the improving chest separation methods does not result in more postoperative pain or use of analgesic when compared with open thyroidectomy.

【Key words】 Endoscopic; Thyroidectomy; Postoperative pain

腔镜甲状腺切除术(endoscopic thyroidectomy,ET)是微创外科近年新开展的手术。该技术可使切口微小化并将其转移至身体的隐蔽部位,取得颈部无手术瘢痕的美观效果。经胸乳入路ET不同于一般的腹部腹腔镜手术,它需要将胸前壁分离较大的皮下面积以制造手术空间。

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