頸部微創內視鏡輔助與雙側腋窩乳暈入路機器人甲狀腺切除手術病患術後生活品質之研究

Comparisons of Postoperative Quality of Life between Minimally Invasive Video-Assisted Thyroidectomy and Bilateral Axillo-Breast Approach Robotic Thyroidectomy

陳維信(Wei-Hsin Chen)

指導教授 ： 陳志毅

中山醫學大學/醫學院/醫學研究所/博士(2022年)

https://doi.org/10.6834/csmu202200109

摘要

不同內視鏡甲狀腺切除手術的方法，其所使用的切口會對患者造成不可避免的身體創傷，因為術後組織纖維化和疤痕會影響病患術後的生活品質。在過去，大多數研究都討論了不同類型的內視鏡甲狀腺切除手術相較於傳統手術的手術安全問題，但是關於術後生活品質的討論較少。由於大多數因癌症或良性疾病接受甲狀腺切除手術的患者可能獲得長期存活，因此有必要研究內視鏡手術後的相關問題。本研究以頸部微創內視鏡輔助甲狀腺切除手術 (MIVAT) 和雙側腋窩乳暈入路 (BABA) 機器人甲狀腺切除手術患者的術後生活品質作調查。從 2015 年 7 月到 2017 年 12 月，回溯性研究包含了 95 名患者其中60 名接受 MIVAT 和 35 名接受 BABA 機器人甲狀腺切除術。比較兩組患者的各項基本特徵、手術適應症、術後病理結果、術後疼痛評分、併發症比例、疤痕感知和術後生活總體滿意度。手術至少2年後使用患者疤痕評估問卷 (PSAQ) 評估美容結果和 SF-36健康量表評估生活總體滿意度。結果兩組之間的疤痕感知沒有統計學上的顯著差異。然而，在 SF-36 健康量表中，MIVAT 組在整體健康、活力、心理健康和健康變化方面的滿意度優於 BABA 機器人組。結論，在仔細選定的患者中可以安全地進行 MIVAT 和 BABA 機器人甲狀腺切除手術，接受 MIVAT 的患者術後生活品質優於接受 BABA 機器人甲狀腺切除手術的患者。

關鍵字

內視鏡甲狀腺切除手術 ； 機器人甲狀腺切除手術 ； 美容性結果 ； 術後生活品質

並列摘要

Different approaches to endoscopic thyroidectomy utilize incisions that result in inevitable physical trauma to patients since postoperative tissue fibrosis and scars will influence their quality of life for a lifetime. Over the past few years, most studies have discussed the safety concerns of different kinds of endoscopic thyroidectomy; conversely, there has been less discussion on postoperative quality of life. Because most patients undergoing thyroidectomy for cancer or benign diseases are likely to have long-term survival, it is essential to study the cosmetic outcome of patients’ scars from minimally invasive video-assisted thyroidectomy (MIVAT) and bilateral axillo-breast approach (BABA) robotic thyroidectomy on quality of life. From July 2015 to December 2017, 95 patients—60 who underwent MIVAT and 35 who underwent BABA robotic thyroidectomy—were retrospectively studied. Patient demographics, operative indications, pathologic findings, pain scores after surgery, complications, perception of scars, and overall satisfaction were compared between the two groups. The cosmetic outcome and overall satisfaction were evaluated at least 2 years after the operation using the patient scar assessment questionnaire and the 36-item short form health survey (SF-36). There was no statistically significant difference in scar perception between the two groups. However, in the SF-36, the MIVAT group had better satisfaction than the BABA robotic group regarding general health, vitality, mental health, and health change. MIVAT and BABA robotic thyroidectomy can be safely performed in selected patients, and patients who underwent MIVAT had better postoperative qualities of life than those who underwent the BABA robotic approach.

並列關鍵字

BABA thyroidectomy ； cosmetic result ； Endoscopic thyroidectomy ； MIVAT ； Robotic thyroidectomy ； postoperative quality of life

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