充气法经腋腔镜下胸锁乳突肌前缘与胸锁乳突肌间隙入路治疗甲状腺乳头状癌的比较

Comparison of air filled anterior approach of sternocleidomastoid muscle and space of sternocleidomastoid muscle for treatment of thyroid papillary carcinoma under axillary endoscope

目的探讨充气法经腋腔镜下胸锁乳突肌前缘与胸锁乳突肌间隙入路在甲状腺乳头状癌切除术中的应用价值。方法回顾分析2021年3月至2023年3月南通大学附属医院甲乳外科实施的180例经腋完全腔镜下甲状腺癌手术患者的临床资料。男27例,女153例,年龄(37.5±8.0)岁(27~52岁)。100例采用胸锁乳突肌前缘入路,80例采用胸锁乳突肌间隙入路。比较两组患者术后的疗效、并发症、满意度。结果两组在淋巴结清扫数量(使用纳米碳示踪剂)、住院天数、术后并发症(短暂性甲状旁腺功能降低、喉返神经损伤)方面差异均无统计学意义(均P>0.05)。胸锁乳突肌前缘入路建腔时间更短[(17.8±2.9)min比(20.1±3.7)min]、术后第2天引流量更少[(18.7±5.2)ml比(23.5±6.3)ml]、术后颈部不适感更轻(P<0.05)。结论经腋完全腔镜下胸锁乳突肌前缘入路在建腔时间、术后第二天引流量、术后减少颈部不适等方面有一定优势,手术方式较为安全、可靠。

Objective To evaluate the application of the anterior sternocleidomastoid muscle approach in transaxillary endoscopic thyroidectomy.Methods The clinical data of 180 patients undergoing transaxillary endoscopic thyroidectomy for thyroid cancer in the Department of General Surgery of the Affiliated Hospital of Nantong University from March 2021 to March 2023 were retrospectively analyzed.There were 27 males and 153 females,aged(37.5±8.0)years,range:27 to 52 years.The anterior approach of sternocleidomastoid muscle was used in 100 cases,and the interspace approach of sternocleidomastoid muscle was used in 80 cases between the two groups.The postoperative efficacy,complications and satisfaction of the two groups were compared.Results There was no difference between the two groups in the number of lymph node dissection(using nano carbon tracer),hospital stay,and postoperative complications(transient decrease in parathyroid function,laryngeal nerve injury)(P>0.05).The anterior approach of sternocleidomastoid muscle had shorter cavity building time[(17.8±2.9)vs(20.1±3.7)min],less drainage volume the second day after operation[(18.7±5.2)vs(23.5±6.3)ml],and less discomfort in the neck(P<0.05).Conclusion The anterior approach of sternocleidomastoid muscle under complete transaxillary endoscopy has certain advantages in the time of cavity construction,the drainage volume the second day after the operation,and the reduction of cervical discomfort after the operation.The operation is safe and reliable.