目的    分析胸乳径路内镜甲状腺手术皮下分离面积大小对手术技术参数和效果的影响。方法    2011年9月至2011年12月第二军医大学附属长征医院将接受内镜甲状腺手术的病人随机分为两组：胸乳径路标准分离组和乳腺切口胸壁径路有限分离组，对比分析两种手术方式在手术时间、出血量、切口长度、术后疼痛和引流量的差异。结果    标准组皮下分离面积显著＞有限分离组［（137.07±26.28）cm2 vs. （92.07±17.41）cm2，P＜0.05］。但两组在手术时间、出血量、切口长度差异无统计学意义。术后疼痛［VAS （3.93±1.94） vs.（4.13±1.06），P =0.729］和引流量［（124.00±28.98） mL vs.（109.00±27.46）mL，P=0.327］组间差异无统计学意义。结论    内镜甲状腺手术皮下分离面积并非术后疼痛的主要原因，注重分离的正确层面有助于降低创伤。

Influence of subcutaneous dissection area on the surgical indexes of endoscopic thyroidectomy        ZHANG Wei，QIU Ming，SHAN Cheng-xiang，et al. Third Division of Department of General Surgery，Changzheng Hospital Affiliated to Second Military Medical University，Shanghai 200003，China
Corresponding author: QIU Ming，E-mail：qiuming2006@yahoo.cn
Abstract    Objective    To analyze the influence of subcutaneous dissection area on surgical indexes and results of breast approach endoscopic thyroidectomy. Methods    Patients underwent endoscopic thyroidectomy between September 2011 and December 2011 in Changzheng Hospital Affiliated to Second Military Medical University were randomized allotted into standard dissection group and limited dissection group. Operative duration，blood loss, total length of incisions，postoperative pain and drainage volume were compared between two groups. Results    Subcutaneous dissection area was significantly larger in standard group than that in limited dissection group ［（137.07±26.28）cm2 vs.（92.07±17.41）cm2，P＜0.05］. But there was no significant difference in operative duration，blood loss and length of incisions between two groups. There was also no significant difference in postoperative pain (VAS （3.93±1.94） vs.（4.13±1.06），P=0.729) and drainage volume （124.00±28.98）mL vs.（109.00±27.46）mL，P=0.327) between two groups. Conclusion Subcutaneous dissection area of endoscopic thyroidectomy is not the influential factor contributing to postoperative pain. Getting into the right dissection plane should be emphasized.