【摘要】 目的 这项前瞻性研究比较了接受传统的甲状腺切除术和胸乳入路的腔镜甲状腺切除术的患者的术后疼痛。方法 分析了2018年9月1日至 2020年12月1日收治的甲状腺疾病患者92例，将患者分为腔镜甲状腺手术组（n=42）和传统开放手术组（n=50），通过比较两组患者的年龄、身体质量指数（BMI）、甲状腺疾病的类型和手术侧别、肿块的大小、带管时间、手术持续时间、术中出血量、切口的总长度、手术的游离范围，通过视觉模拟评分法（VAS）对术后1小时、术后4小时、术后第一天、术后第三天、术后第七天进行疼痛评分。结果 两组患者手术均顺利完成，传统手术组与腔镜组患者的术后带管时间 [（4.98±0.82）d vs (3.86±0.81)d（P＜0.01）] ，手术时间 [（88.72±15.10）min vs (109.60±17.01) min （P＜0.01）], 术中出血量 [（23.50±5.91）m L vs (5.52±2.43)m L （P＜0.01）], 术后1小时的疼痛评分 [（2.98±0.59）vs (2.74±0.73)（P＞0.05）], 术后4小时的疼痛评分 [（3.28±0.81）vs (3.00±0.70)（P＞0.05）], 术后第一天的疼痛评分[（4.38±0.64）vs (3.60±0.50)（P＜0.01）], 术后第三天的疼痛评分[（3.90±0.58）vs (3.31±0.47)（P＜0.01）], 术后第七天的疼痛评分[（2.38±0.64）vs (1.69±0.64)（P＜0.01）],切口的总长度 [（5.38±0.60）cm vs ( 2.79±0.25) cm（P＜0.01）], 手术的游离范围 [（44.25±8.51）cm2 vs ( 68.91±6.24)cm2（P＜0.01）]，剩余观察指标差异无统计学意义（P＞0.05）。结论 腔镜甲状腺手术组患者尽管手术时间更长且手术游离范围更大解剖范围更广，但与传统甲状腺手术组相比术后疼痛程度更低，更有利于患者术后恢复。

【Abstract】Objective This prospective study compared postoperative pain in patients undergoing conventional thyroidectomy with endoscopic thyroidectomy with a modified breast approach. Methods Analyses on September 1, 2018 to December 1, 2020 of 92 patients with thyroid disease, according to the principle of randomized divided the patients into cavity mirror thyroid surgery group (n = 42) and traditional open surgery group (n = 50), by comparing the two groups of patient's age, body mass index (BMI), thyroid disease type and operation side, lump size, with tube time, duration of surgery, intraoperative blood loss, the total length of the incision, operation of free range, Visual analogue scale (VAS) was used to score the pain at 1 hour, 4 hours, the first day, the third day and the seventh day after surgery. Results The operation was successfully completed in both groups. The catheter time in the conventional surgery group and the complete endoscopic group [(4.98±0.82)d vs. (3.86±0.81)d (P < 0.01)], Operative time [(88.72±15.10) min vs (109.60±17.01) min (P < 0.01)], intraoperative blood loss [(23.50±5.91) mL vs (5.52±2.43) mL (P < 0.01)], postoperative pain score one hour [(2.98±0.59) vs (2.74±0.73) (P > 0.05)], The pain scores 4 hours after surgery [(3.28±0.81) vs (3.00±0.70) (P > 0.05)], the pain scores on the first day after surgery [(4.38±0.64) vs (3.60±0.50) (P < 0.01)], and the pain scores on the third day after surgery [(3.90±0.58) vs (3.31±0.47) (P < 0.01)]. The pain score on the seventh day after the operation [(2.38±0.64) vs (1.69±0.64) (P < 0.01)], the total length of the incision [(5.38±0.60) cm vs (2.79±0.25) cm (P < 0.01)], and the free range of the operation [(44.25±8.51) cm2 vs (68.91±6.24) cm2 (P < 0.01)]，There was no significant difference in the remaining outcomes（P＞0.05） . Conclusion Compared with the traditional thyroid surgery group, the endoscopic thyroid surgery group has lower postoperative pain and is more conducive to postoperative recovery, although the operation time is longer and the surgical free area is larger and the anatomical area is wider.