Ethan Frank , Joshua Park , Christopher Vuong , Lydia Kore , Alfred Simental
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引用次数: 1
Abstract
Objective
Minimally invasive video-assisted thyroidectomy (MIVAT) is among the most common alternatives to conventional open thyroidectomy. Previous reports have shown it to be safe and effective in patients without neck surgery history. However, this contraindication has been called into question in more recent small series. This study aims to evaluate the efficacy and safety of MIVAT in patients with prior neck surgery.
Methods
We retrospectively reviewed the data of 178 patients who underwent completion thyroidectomy in the Department of Otolaryngology-Head and Neck Surgery at Loma Linda University Medical Center between July 2004 and July 2017. Patients were divided into MIVAT group and Conventional group based on method of surgery, and analysis with two sample tests of proportions was carried out as appropriate.
Results
Patients in MIVAT group had significantly shorter operative time (74.1 ± 26.4 min vs. 99.0 ± 49.3 min, p < 0.001), less estimated blood loss (19.5 ± 15.0 mL vs. 39.0 ± 65.9 mL, p = 0.002), smaller incision size (3.5 ± 1.1 cm vs. 6.2 ± 2.2 cm, p < 0.001), and a lighter thyroid weight (7.5 ± 5.2 g vs. 20.5 ± 31.1 g, p < 0.001). The average length of stay was a half day longer, and post-operative admission was higher (78.8% vs. 51.7%, p = 0.005) in MIVAT group, while most was for routine 23-hour observation (63.6% vs. 35.9%, p = 0.009). There were no differences in complications.
Conclusion
MIVAT is feasible for re-operative patients with equivalent or superior outcomes to those of conventional thyroidectomy, and no significant difference in the incidences of common postoperative complications.
目的:微创视频辅助甲状腺切除术(MIVAT)是传统开放式甲状腺切除术最常用的替代方法之一。以前的报告表明,对于没有颈部手术史的患者,它是安全有效的。然而,这一禁忌症在最近的小系列研究中受到了质疑。本研究旨在评估MIVAT在既往颈部手术患者中的疗效和安全性。方法回顾性分析2004年7月至2017年7月在洛马林达大学医学中心耳鼻喉头颈外科行甲状腺完全切除术的178例患者的资料。根据手术方式将患者分为MIVAT组和Conventional组,并酌情采用两次样本比例检验进行分析。结果MIVAT组患者手术时间明显缩短(74.1±26.4 min vs. 99.0±49.3 min);0.001),更少的估计失血量(19.5±15.0 mL vs 39.0±65.9 mL, p = 0.002),更小的切口尺寸(3.5±1.1 cm vs 6.2±2.2 cm, p <0.001),甲状腺重量较轻(7.5±5.2 g vs. 20.5±31.1 g, p <0.001)。MIVAT组患者平均住院时间延长半天,术后住院率较高(78.8% vs. 51.7%, p = 0.005),而大多数患者为常规观察23小时(63.6% vs. 35.9%, p = 0.009)。并发症发生率无差异。结论mivat对于再手术患者是可行的,其疗效等同于或优于常规甲状腺切除术,且术后常见并发症发生率无显著差异。
期刊介绍:
Laparoscopic, Endoscopic and Robotic Surgery aims to provide an academic exchange platform for minimally invasive surgery at an international level. We seek out and publish the excellent original articles, reviews and editorials as well as exciting new techniques to promote the academic development.
Topics of interests include, but are not limited to:
▪ Minimally invasive clinical research mainly in General Surgery, Thoracic Surgery, Urology, Neurosurgery, Gynecology & Obstetrics, Gastroenterology, Orthopedics, Colorectal Surgery, Otolaryngology, etc.;
▪ Basic research in minimally invasive surgery;
▪ Research of techniques and equipments in minimally invasive surgery, and application of laparoscopy, endoscopy, robot and medical imaging;
▪ Development of medical education in minimally invasive surgery.