全腔镜手术与传统手术治疗早期分化型甲状腺癌的临床比较

Totally endoscopic thyroidectomy versus traditional operation for early-stage differentiated thyroid carcinoma

目的：探讨腔镜下治疗早期分化型甲状腺癌可行性及临床应用价值。方法：回顾性分析2010年1月—2013年6月收治的75例早期分化型甲状腺癌患者临床资料，其中15例患者行全腔镜甲状腺切除术（腔镜手术组），60例患者行传统手术（传统手术组），所有患者均至少行患侧腺叶及峡部切除加中央区淋巴结清扫。比较两组的主要各项临床指标及术后美容效果。结果：15例腔镜手术患者均获得成功，无中转开放手术病例，无术后大量出血患者。腔镜手术组手术时间略长于传统手术组，但差异无统计学意义（P=0.059）；两组均无术后低钙血症及声音嘶哑并发症，两组术中出血量、术后引流量、住院天数、中央淋巴结清扫数差异均无统计学意义（均P〉0.05）。两组患者术后随访6~36个月，均无复发病例，腔镜手术组患者的手术瘢痕小且隐蔽，美容效果明显好于传统手术组。结论：腔镜下治疗早期分化型甲状腺癌是安全可行，有良好美容效果。

Objective： To evaluate the feasibility and clinical value of endoscopic thyroidectomy for early-stage differentiated thyroid carcinoma （DTC）.Methods： The clinical data of 75 patients with early-stage DTC treated between January 2010 and June 2013 were retrospectively analyzed. Of the patients, 15 cases received totally endoscopic thyroidectomy （endoscopic operation group） and 60 cases were subjected to traditional open surgery （traditional operation group）. All patents underwent at least resection of the affected lobe and isthmus plus central compartment neck dissection. The main clinical variables and postoperative cosmetic results between the two groups were compared.Results： Totally endoscopic thyroidectomy was successfully completed in all of the 15 patients without open conversion or postoperative massive hemorrhage. The operative time in endoscopic operation group was somewhat longer than that in traditional operation group, but the difference did not reach a statistical significance （P=0.059）; there were no cases of postoperative hypocalcemia or hoarseness in any of the groups, and the clinical variables that included intraoperative blood loss, postoperative drainage volume, length of hospital stay and number of resected lymph nodes from the central compartment between the two groups showed no statistical difference （all P〉0.05）. Patients in the two groups were followed up for 6 to 36 months; no recurrence was noted, and the scars in patients of endoscopic operation group were small and not conspicuous, which yielded obviously better cosmetic results compared with traditional operation group.Conclusion： Totally endoscopic thyroidectomy for early-stage DTC is safe and feasible, with excellent cosmetic effect.