摘要
目的:评估改良Miccoli模式内镜甲状腺手术不同阶段,不同手术条件及技术水平的手术时间、出血量、中转开放手术率及并发症等,探讨改良Miccoli模式内镜甲状腺手术的学习曲线及其影响因素。方法:回顾性分析2005年6月～2008年6月改良Miccoli模式内镜甲状腺手术治疗的甲状腺良性肿瘤患者362例,主刀为同一医师,按手术先后次序分为3组,每组30例(肿块大小和部位因素除外),比较各组手术时间、出血量、中专率及并发症等发生情况。结果:学习曲线:A组手术时间(104.3±29.6)min,B组手术时间(79.5±21.9)min,C组手术时间(73.67±17.6)min。A组与B组和C组比较手术时间有显著性差异,A组2例因出血中转常规手术,1例术后暂时性喉返神经损伤,出血量各组无显著性差异。影响因素:2～4cm的肿块较小于1cm及大于5cm者,手术时间明显缩短,出血量明显减少。中上部分的肿块较其它部位的肿块手术时间明显短,出血量也有显著性差异。建腔技术,成像技术及超声刀止血技术均对手术时间有明显影响,但出血量无显著性差异。腺叶切除术的手术方式比腺叶部分切除术手术时间长,且有2例术后暂时性喉返神经损伤,出血量同样有显著性差异。结论:改良Miccoli模式内镜甲状腺手术学习曲线大约需30例左右经验积累,即可达到较熟练程度。先进的技术设备,选择恰当的患者及较简单的手术方式可钝化学习曲线。
Objective：To evaluate the operative time,blood loss,conversion rate toopen surgery,and operative complications formodi-fied Miccoli mode endoscopic thyroidectomy at different stages,under different surgical conditions and with diffrent techniques,in order to explore the learning curve of modified Miccoli mode endoscopic thyroidectomy and its influence factors.Methods：Clinical data of 362 operative cases of benign thyroid tumore performed between June 2005 and June2008 by a single doctor were reviewed.The patients were sequentially divided into three groups,with 30 cases in each group（without considering the size and site of the mass）.The operative time,blood loss,conversion rate to open surgery and operative complications were compared between the three groups.Results：The op-erative time in group A,group B and group C were（104.3±29.6）min,（79.5±21.9）min,and（73.67±17.6）min,respectively.There were significant differences in operative time,between the three groups.2 patients in group A converted to open surgery for blood loss,and 1 patient had a temporary injury of recurrent laryngeal nerves.There were significant differences blood loss between the three groups.The influencing factors were as follows.The operative time for the masses of 2 to 4 centimeters was significantly shorter than that for the masses of shorter than 1 centimeter or longer than 5 centimeters.The size cased the same difference for the blood loss.The operative time for the masses in the middle and upper part was significantly shorter than the masses in other parts,the site also did bring about sig-nificant differences in blood loss.The technique of constructing cavity,imaging and ultrasonic calpel to stop bleeding had obvious impact on operative time and blood loss.The operative time for radical thyroidectomy was longer than than for partial thyroidectomy,while 2 pa-tients had a temporary injury of recurrent laryngeal nerves after the adical thyroidectomy.The significant differences in blood loss were found.Conclusion：The learning curve of the modified Miccoli mode endoscopic thyroidectomy requires approximately 30 cases to achieve more proficiency.Advanced technology and equipment,proper choice of patients and simple way of operation can passivate the learning curve of this kind.
出处
《重庆医科大学学报》
CAS
CSCD
北大核心
2010年第8期1267-1270,共4页
Journal of Chongqing Medical University
