探讨达芬奇机器人手术系统采用单侧腋窝双侧乳晕术式治疗良性甲状腺结节的临床疗效、创 伤应激反应及远期疗效。方法：采用前瞻性非随机化队列研究的方法，招募 2017 年 12 月 ~2019 年 6 月就诊于中 国人民解放军联勤保障部队第 940 医院普通外科行手术治疗的良性甲状腺结节患者共 102 例。其中 53 例患者行达 芬奇机器人甲状腺切除手术，设为机器人组。49 例患者行传统开放甲状腺切除手术，设为开放组。收集患者基本 信息及围手术期相关临床指标进行比较，术后采用门诊或电话的形式重点对出现吞咽功能、美容效果、胸部感觉 异常、永久性喉返神经损伤、声带损伤等并发症的患者进行随访。在术后第 1 个月、3 个月、6 个月个月进行喉镜 检查声带，超过 6 个月的喉返神经损伤定义为永久性喉返神经损伤。结果：机器人组手术时间长于开放组，手术 费用高于开放组，术中出血量少于开放组。两组患者在年龄、性别、BMI、结节直径、术后住院时间、总引流量、 术后并发症、术后 24h 和 48h 疼痛评分方面比较，均无明显差异。机器人组术后 24h IL-6、CRP 明显低于开放组， 机器人组术后 48h CRP 明显低于开放组。随访结果显示，达芬奇机器人甲状腺切除术在术后 12h 疼痛评分、术后 美容评分及吞咽功能优于传统开放甲状腺切除术，颈部损伤方面则劣于传统开放甲状腺切除术，两组患者间语音 障碍评分比较，差异无统计学意义。结论：达芬奇机器人手术系统治疗良性甲状腺结节安全可行，具有侵入性低、 吞咽功能及美容效果好等优势。

To study the clinical effect, traumatic stress response and long-term effect of benign thyroid nodules treated by unilateral axillary bilateral areola with Da Vinci robotic surgery system. Methods: Prospective nonrandomized cohort study was taken and 102 patients who had been treated for benign thyroid nodules during Dec.2017 and Jul.2019 at the 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army were selected.53 patients were treated with Da Vinci robotic thyroidectomy as the robotic group, others were performed traditional open thyroidectomy as the open group. Basic information and related clinical indicators in perioperation of the selected 102 patients were collected for comparing. Information on swallowing function, cosmetic results, chest paresthesia, permanent recurrent laryngeal nerve injury and vocal cord injury were mainly collected by following-up in clinic or telephone after operation. Furthermore, the patients’ vocal cords were respectively examined with laryngoscope at the first, third and sixth months after the surgeries, and recurrent laryngeal nerve injury which last more than six months can be defined as permanent injury. Results: No case in robotic group converted to open group during the study. The robotic group has a longer operation time than the open group, and operation cost of robotic group is also higher than the open group. However, the intraoperative blood loss of the former is less than the latter .There were no significant differences between the two groups in terms of ages, gender, BMI, nodule diameter, postoperative hospitalization time, total drainage, postoperative complications, and the pain scores after 24 and 48 hours operation respectively.After 24 hours of the operation, the interleukin-6 (IL-6) and C-reactive protein (CRP) in the robot group were significantly lower than those in the open group. Besides, after 48 hours of the operation, the CRP in the robot group was significantly lower than that in the open group. Follow-up results showed that the robotic group’s 12-hour postoperative pain score , the postoperative beauty score and the swallowing function were all better than those in the open group. However, the neck injury of the robotic group was worse than the open group. In terms of the voice handicap index, these two groups have similar trend.Conclusion: The Da Vinci robotic surgery system is safe and feasible in treating benign thyroid nodules.It proved to be better outcome in swallowing function and cosmetic effects with less invasiveness than conventional open thyroidectomy.

收稿日期：2020-03-02  录用日期：2020-04-23 

Received Date: 2020-03-02  Accepted Date: 2020-04-23 

基金项目：甘肃省自然科学基金（1606RJZA177） 

Foundation Item: Natural Science Foundation of Gansu Province (1606RJZA177) 

通讯作者：刘宏斌，Email：liuhongbin999@163.com 

Corresponding Author: LIU Hongbin, Email: liuhongbin999@163.com 

引用格式：张安，陈为凯，黄小段，等 . 机器人手术与传统开放手术治疗甲状腺良性结节的临床疗效及创伤应激反应对比分析 [J]. 机器人外科学杂志，2020，1（3）：186-194. 

Citation: ZHANG A, CHEN W K, HUANG X D, et al.Comparative analysis on clinical efficacy and traumatic stress of benign thyroid nodules treated with robotic surgery and traditional open surgery[J].Chinese Journal of Robotic Surgery, 2020,1(3):186- 194.

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