全乳晕入路与胸乳入路腔镜手术治疗甲状腺微灶癌的临床比较

Clinical comparison of complete areolar approach and chest/breast approach for endoscopic thyroidectomy of papillary thyroid microcarcinoma

目的:比较全乳晕入路和经胸乳入路腔镜甲状腺微灶癌手术的临床效果。方法:回顾性分析2014年1月—2015年6月甲状腺微灶癌患者行腔镜下甲状腺腺叶+峡部切除与中央组淋巴结清扫术50例,其中行全乳晕入路21例(全乳晕组),胸乳区入路29例(胸乳组),比较两组患者的相关临床指标。结果:两组患者年龄、肿瘤最大直径差异无统计学意义(均P>0.05)。两组患者均在腔镜下顺利完成手术,全乳晕组与胸乳组比较,平均淋巴结清扫数目(5.90枚vs.6.07枚)、手术时间(99.95 min vs.99.17 min)、术中出血量(23.81 m L vs.28.21 m L)、住院时间(5.19 d vs.6.07 d)、术后疼痛评分及术后并发症发生率差异均无统计学意义(均P>0.05);全乳晕组患者对手术切口满意度明显高于胸乳组(8.81vs.6.59,P<0.0001)。结论:全乳晕入路腔镜甲状腺手术与胸乳入路腔镜甲状腺手术在治疗甲状腺微灶癌方面疗效相当,全乳晕入路具有更好的美容效果,是一种安全理想的手术方式。

Objective： To compare the clinical efficacy of complete areolar approach and chest/breast approach for endoscopic thyroidectomy of papillary thyroid microcarcinoma. Methods： The clinical data of 50 patients with papillary thyroid carcinoma undergoing endoscopic resection of the thyroid lobe and isthmus and central neck dissection from January 2014 to June 2015 were retrospectively analyzed. Endoscopic thyroid surgery was performed via complete areolar approach in 21 cases （complete areolar group） and via chest/breast approach in 29 cases （chest/breast group）. The main clinical variables between the two groups of patients were compared. Results： There was no statistical difference in age and maximum diameter of tumor between the two groups of patients （both P〉0.05）. Endoscopic surgery was successfully completed in all patients. In complete areolar group versus chest/breast group, all the variables that included the average number of resected lymph nodes （5.90 vs. 6.07）, operative time （99.95 min vs. 99.17 min）, intraoperative blood loss （23.81 mL vs. 28.21 mL）, length of hospital stay （5.19 d vs. 6.07 d）, and postoperative pain score as well as incidence of postoperative complications had no statistical difference （all P〉0.05）, but the degree of patients’ satisfaction with surgical incision in complete areolar group was significantly higher than that in chest/breast group （8.81 vs. 6.59, P〈0.0001）.Conclusion： For papillary thyroid microcarcinoma, endoscopic thyroidectomy via complete areolar approach has equivalent clinical efficacy to that via chest/breast approach, but the former offers better cosmetic results, so it is a safe and favorable approach.