目的对比经胸乳途径腔镜下甲状腺手术与传统甲状腺手术的疗效,观察患者对两种术式的认可度。方法回顾本院2019年9月-2021年1月收治的74例甲状腺良性肿瘤患者的临床资料,按手术入路分传统组(30例)和经胸乳组(44例),传统组均按传统术式完成甲状腺切除,经胸乳组均经胸乳入路行腔镜下甲状腺切除。比较2组手术耗时、术中出血量、术后引流量、住院天数、疼痛程度、并发症发生情况和手术满意度。结果2组患者均顺利完成既定手术,除术后引流量2组间无统计学差异外,经胸乳组患者的手术耗时、术中出血量、住院天数、VAS评分均优于传统组,差异有统计学意义(74.40±9.35min VS 112.20±12.45min,35±5mL VS 70±9mL,4.75±1.23d VS 10.20±1.78d,3.25±0.56 VS 6.42±1.22,P均<0.05)。传统组并发症发生率高于经胸乳组,差异有统计学意义(20.00%VS 4.55%,P<0.05)。经胸乳组患者的满意度明显高于传统组,差异有统计学意义(72.73%VS 60.00%,P<0.05)。结论与传统甲状腺切除手术比较,经胸乳组胸乳入路腔镜下甲状腺切除术式具有手术时间短、出血量少、患者恢复快、切口美观、患者满意度高等优点,值得推广应用。
BACKGROUND In traditional descriptions,the upper surface of the liver is smooth and convex,but deep depressions are variants that are present in 5%-40%of patients.We sought to determine the relationship between surface depressions and the diaphragm.AIM To use exploratory laparoscopy to determine the relationship between surface depressions and the diaphragm.METHODS An observational study was performed in all patients undergoing laparoscopic upper gastro-intestinal operations between January 1,2023 and January 20,2024.A thirty-degree laparoscope was used to inspect the liver and diaphragm.When surface depressions were present,we recorded patient demographics,presence of diaphragmatic bands,rib protrusions and/or any other source of compression during inspection.RESULTS Of 394 patients,343 had normal surface anatomy,and 51(12.9%)had prominent surface depressions on the liver.There was no significant relationship between the presence of surface depressions and gender nor the presence of rib projections.However,there was significant association between the presence of surface depressions and diaphragmatic muscular bands(P<0.001).CONCLUSION With these data,the diaphragmatic-band theory has gained increased importance over other theories for surface depressions.Further studies are warranted using cross sectional imaging to confirm relationships with intersectional planes as well as beta-catenin assays in the affected liver parenchyma.
Shamir O CawichDexter A ThomasFawwaz MohammedMichael T GardnerMarlene CraigieShaneeta JohnsonRamnanand S Kedambady
