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目的:比较颈前小切口入路甲状旁腺肿瘤手术及改良Miccoli腔镜甲状旁腺肿瘤手术的疗效。方法:33例甲状旁腺肿瘤患者分别行颈前小切口入路(颈前小切口组,n=20)和改良Miccoli腔镜(改良Miccoli组,n=13)甲状旁腺肿瘤手术,比较两组的手术时间、颈部引流量、美容满意度、术后住院时间、住院费用、手术并发症及术后甲状旁腺激素(PTH)水平。结果:手术时间颈前小切口组明显长于改良Miccoli组([72.3±16.6)min比(52.4±12.7)min],差异有统计学意义(P<0.05)。美容满意度评分和住院费用改良Miccoli组明显高于颈前小切口组[(4.1±0.2)分比(3.0±0.3)分;(10213.7±898.4)元比(6120.4±1467.2)元],差异均有统计学意义(P<0.05)。术后引流量和住院时间颈前小切口组均要高于改良Miccoli组([31.4±3.6)ml比(18.9±2.2)mL;(5.8±1.7)d比(4.2±1.1)d],但差异均无统计学意义(P>0.05)。两组甲状旁腺激素(PTH)水平均于术后3天降至正常水平。两组各有1例术后出现声音嘶哑,均于术后3个月恢复正常。结论:颈前小切口入路和改良Miccoli腔镜甲状旁腺肿瘤手术均可以达到常规手术切口切除范围,并发症与传统手术相当,在颈部美容效果方面,改良Miccoli腔镜要优于颈前小切口入路,但前者住院费用要明显高于后者,两种方式均能达到对肿瘤的完整切除,术后甲状旁腺激素均能降至正常水平。
Objective: To compare the effect of small incision parathyroid tumor surgery and modified Miccoli endoscopic parathyroid tumor surgery. Methods: Twenty-three patients with parathyroid tumor underwent small anterior cervical incision (small anterior cervical incision group, n = 20) and modified Miccoli endoscopic (modified Miccoli group, n = 13) parathyroid tumor surgery. The operation time, neck drainage, cosmetic satisfaction, postoperative hospital stay, hospitalization costs, operative complications and postoperative parathyroid hormone (PTH) levels were analyzed. Results: The operative time was significantly longer in the small anterior cervical incision group than in the modified Miccoli group ([72.3 ± 16.6] min vs (52.4 ± 12.7) min], the difference was statistically significant (P <0.05). The scores of cosmetic satisfaction and hospitalization in modified Miccoli group were significantly higher than those in the small incision group [(4.1 ± 0.2) (3.0 ± 0.3); (10213.7 ± 898.4) yuan (6120.4 ± 1467.2) yuan] There was statistical significance (P <0.05). The volume of postoperative drainage and length of stay in the anterior cervical incision were significantly higher than those in the modified Miccoli group ([31.4 ± 3.6] ml vs (18.9 ± 2.2) mL; (5.8 ± 1.7) d vs. (4.2 ± 1.1) d] There was no significant difference (P> 0.05). The levels of parathyroid hormone (PTH) in both groups dropped to normal levels 3 days after the operation. One patient in each group had hoarseness after operation, both of whom returned to normal after 3 months. Conclusion: The small anterior cervical incision and modified Miccoli endoscopic parathyroid tumor surgery can reach the scope of conventional surgical excision, the complications are comparable with the traditional surgery. In terms of the cosmetic effect of the neck, the modified Miccoli laparoscopy is better than the cervical Small incision approach, but the former hospitalization costs were significantly higher than the latter, both ways can achieve complete resection of the tumor, postoperative parathyroid hormone can be reduced to normal levels.