不同手术方法治疗甲状腺乳头状癌的疗效比较

Comparison of the efficacy of different surgical methods for treating papillary thyroid carcinoma

目的比较不同手术方法治疗甲状腺乳头状癌的临床效果。方法选择我院2012年1月~2016年1月行手术治疗的甲状腺乳头状癌患者172例分为两组,每组86例,腔镜组行腔镜下甲状腺切除术,对照组行开放性手术,对两组的手术效果进行比较分析。并比较两组的术中出血量、淋巴级清扫数量、VAS评分、NSS评分、并发症情况。结果腔镜组患者的术中出血量(55.4±3.8)mL,淋巴结清扫数量(8.2±1.1)枚,分别与对照组比较,差异具有统计学意义(P<0.05),腔镜组患者术后12 h、24 h、48 h的VAS评分分别显著低于对照组,差异具有统计学意义(P<0.05)。腔镜组患者的NSS评分为(7.8±1.3)分,对照患者的NSS评分为(3.5±1.8)分,腔镜组患者的NSS评分显著高于对照组,差异具有统计学意义(P<0.05)。腔镜组术后无一例发生脂肪液化、永久性甲状旁腺功能低、永久性喉返神经损伤,其并发症明显少于对照组,差异具有统计学意义(P<0.05)。结论不同手术方法治疗甲状腺乳头状癌均可以取得较好的效果,但腔镜下甲状腺切除术较开放手术具有手术创伤小、出血少、并发症少,美容效果好等优势,值得临床广泛推广和应用。

Objective To compare the clinical effect of different surgical methods in the treatment of thyroid papillary carcinoma. Methods The surgical effect of 172 patients with papillary thyroid carcinoma who underwent laparoscopic surgery and open surgery in our hospital from January 2012 to January 2016 were compared and analyzed. Endoscopic group underwent endoscopic thyroidectomy, and the control group underwent open surgery.The intraoperative blood loss, lymphatic dissection quantity, VAS score, NSS score and complications were compared between the two groups. Results The intraoperative blood loss was（55.4±3.8） mL, the number of lymph node dissection was （8.2±1.1） in the endoscopic group,which was significantly different from that of the control group, respectively and the difference was significant（P〈 0.05）. The VAS score of the endoscopic group was significantly lower than that of the control group at 12 h, 24 h and 48 h respectively, and the difference was significant（P〈0.05）. The NSS score of patients in endoscopy group was（7.8± 1.3）, significantly higher than（3.5±1.8） of the control group, and the difference was significant（P〈0.05）. There was no case of fat liquefaction, permanent low parathyroid function and permanent recurrent laryngeal nerve injury, and the complications in the endoscopy group were significantly fewer than those of the control group, and the difference was significant（P〈0.05）. Conclusion Thyroid papillary thyroidectomy can achieve great results in treating thyroid papillary carcinoma with different surgical methods. However, laparoscopic thyroidectomy has the advantages of small trauma, less bleeding, fewer complications and good cosmetic effects compared with open surgery,which is worthy of promotion and application.