探讨三维腔镜根治术下甲状腺癌治疗手术入路的选取及创口情况的比较。

回顾性分析2014年6月至2017年4月78例行三维腔镜根治术的甲状腺癌患者，根据手术入路分为胸乳入路组与颈前入路组，其中胸乳入路组40例采取胸乳入路，颈前入路组38例采取颈前入路。数据采用SPSS21.0软件进行统计分析，围术期指标等采用(±s)描述，独立t检验；术后并发症，术后切口美观满意度χ²检验分析，P<0.05差异有统计学意义。

两组患者的术中出血量、术后引流量、手术时间、住院时间、淋巴结清扫数目和术后声音嘶哑、咳嗽、低钙血症等并发症差异无统计学意义(P>0.05)；但术后疼痛评分和吞咽困难发生率胸乳入路组明显低于颈前入路组(P<0.05)，术后切口美观满意度明显高于颈前入路组(P<0.05)。

胸乳入路三维腔镜甲状腺癌根治术的手术疗效良好，安全可靠，并且术后切口更为美观，值得临床进一步推广。

To investigate the choice of surgical approach for the treatment of thyroid cancer undergoing three-dimensional laparoscopic radical surgery and compare the wound conditions.

78 cases of thyroid cancer who underwent three-dimensional laparoscopic surgery in our hospital from June 2014 to April 2017 were retrospectively analyzed. According to the surgical approach, they was divided into thoracic approach group and anterior approach group. Among them, 40 cases of thoracic approach group were given thoracic approach, and 38 cases of anterior approach group were given anterior approach. All data were statistically analyzed using SPSS21.0 software. Perioperative indicators were described using (±s) and compared with independent t test. Postoperative complications and aesthetic satisfaction of postoperative incision were compared by χ² test. The difference was statistically significant at P<0.05.

There were no significant differences in perioperative indexes between the two groups, such as intraoperative blood loss, postoperative drainage, operation time, length of hospital stay, and number of lymph node dissection (P>0.05). However, postoperative pain scores in the thoracic approach group were significantly lower than those in the anterior cervical approach group (P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05), while the incidence of dysphagia in the thoracic approach group was significantly lower than that in the anterior approach group (P<0.05). The aesthetic satisfaction of postoperative incisions in the thoracic approach group was significantly higher than that in the anterior cervical approach group (P<0.05).

3D laparoscopic radical thyroidectomy via thoracic approach is effective, safe and reliable. The postoperative incisions are more aesthetically pleasing.It is worthy of further clinical promotion.