腔镜完全乳晕入路术式与开放术式在甲状腺乳头状癌手术治疗中的应用比较

Bilateral areolar approach endoscopic thyroidectomy versus open thyroidectomy for papillary thyroid carcinoma

目的比较腔镜完全乳晕入路术式与开放术式在甲状腺乳头状癌手术治疗中的近期疗效、安全性,探索腔镜完全乳晕入路术式在甲状腺乳头状癌手术治疗中的应用前景。方法采用回顾性队列研究。按纳入排除标准连续收集2016年3月-2018年3月在解放军总医院第一医学中心普通外科住院行甲状腺乳头状癌根治术患者的临床资料,应用倾向评分匹配(propensity score matching,PSM)法对开放组和腔镜组按照1∶1进行匹配。比较两组手术准备时间、手术时间、出血量、清扫淋巴结个数、并发症、出院时间、住院费用、术后1年复发情况、切口满意度等。结果经PSM法匹配后开放组及腔镜组各44例纳入研究。两组术前一般资料差异无统计学意义(P>0.05)。两组术中资料—手术时间、出血量、是否显露喉返神经、清扫淋巴结个数及阳性淋巴结个数无统计学差异(P>0.05),腔镜组手术准备时间长于开放组[(24.93±4.91)min vs(22.70±4.67)min,P=0.032]。两组术后资料及随访情况—血钙、血甲状旁腺激素、并发症、拔管时间、出院时间、I131治疗、术后1年随访是否复发差异无统计学意义(P>0.05),腔镜组住院费用多于开放组[(21889.51±1895.25)元vs(20659.51±1789.58)元,P=0.002],在切口满意度上优于开放组(90.9%vs 50.1%,P<0.001)。结论腔镜完全乳晕入路术式在甲状腺乳头状癌手术治疗中近期疗效、安全性不劣于传统开放术式,并且具有良好的美容效果,可供有美容需求的人群选择应用。

Objective To compare the short-term effect and safety of bilateral areolar approach endoscopic thyroidectomy versus traditional open surgery in the treatment of papillary thyroid carcinoma,and explore the application prospect of bilateral areolar approach endoscopic thyroidectomy for thyroid papillary carcinoma.Methods A retrospective cohort study was performed.According to the inclusion and exclusion criteria,clinical data about patients undergoing radical resection of thyroid papillary carcinoma in the first medical center of Chinese PLA General Hospital from March 2016 to March 2018 were continuously collected.A one to one propensity score matching(PSM)method was performed for establishing the open group and endoscopy group.Main observational indexes including time for preparing surgery,operating time,blood loss,number of lymph nodes dissected,complications,length of hospital stay,hospitalization cost,local recurrence at 1 year,satisfaction with incision appearance,were compared between the two groups.Results After PSM matching,44 cases were in the open group and 44 cases were in the endoscopy group.There was no significant difference in preoperative general data between the two groups(P>0.05).For intraoperative data,no significant difference was detected in operating time,blood loss,the exposure of recurrent laryngeal nerve,the number of dissected lymph nodes and the number of positive lymph nodes(all P>0.05).The time for preparing surgery in the endoscopy group was significantly longer than that of the open group[(24.93±4.91)min vs(22.70±4.67)min,P=0.032].There was no statistically significant difference in blood calcium,blood PTH,complications,time to remove drainage,length of hospital stay,radioactive Iodine(I131)therapy,and local recurrence in 1 year between the two groups(P>0.05),but the hospitalization cost in the endoscopy group was higher than that in the open group[(21889.51±1895.25 yuan)vs(20659.51±1789.58 yuan),P=0.002].The endoscopy group was superior to the open group in satisfaction with incision appearance(90.9%vs 50.1%,P<0.001).Conclusion Bilateral areolar approach endoscopic thyroidectomy is not inferior to traditional open surgery in safety and short-term effect in the treatment of thyroid papillary carcinoma,but could be an option for patients pursuing good cosmetic effect.