经腋下径路无注气内镜下甲状腺微小乳头状癌手术与传统手术的对照研究

Comparative Study of Trans-axillary Gasless Endoscopic Thyroidectomy versus Conventional Open Thyroidectomy in Papillary Thyroid Microcarcinoma (PTMC) Patients

目的:评价经腋下径路无注气内镜下甲状腺微小乳头状癌手术的可行性、安全性及有效性。方法:回顾性分析39例甲状腺微小乳头状癌患者经腋下径路无注气内镜下手术(内镜组)临床资料,以同期相同诊断78例患者行开放手术(开放组)作为对照,分析内镜组和传统组的手术时间、手术出血量、肿瘤大小、淋巴结清扫个数、淋巴结阳性个数、淋巴结阳性率、引流量、术后住院时间、术后并发症发生率、肿瘤复发率及术后3个月时随访美观满意度等指标。结果:内镜组手术时间较传统组长(86.15±12.54 min vs.50.64±8.03 min,),引流量较传统组多(82.33±21.98ml vs.69.60±16.44ml),术后3个月美容评分较传统组低(1.05±0.22 vs.3.90±1.20),差异均有统计学意义(t=16.730,P<0.05;t=3.213,P=0.002;t=14.673,P<0.001)。两组间手术出血量、肿瘤大小、淋巴结清扫个数、淋巴结阳性个数、淋巴结阳性率、暂时性喉返神经麻痹发生率和暂时性低钙血症发生率及术后疼痛评分差异无统计学意义,两组患者术后随访未见肿瘤复发或转移。结论:经腋下径路无注气内镜下甲状腺微小乳头状癌手术安全、可行、有效,美容效果优于传统手术,可为有美观需求的部分甲状腺微小乳头状癌患者提供新的选择。

Objective： To evaluate its feasibility, validity, and safety of trans axillary gasless endoscopic thyroidectomy in papillary thyroid microcarcinoma （PTMC） patients by compared with conventional open thyroidectomy. Methods： 39 patients with PTMC received trans axillary gasless endoscopic thyroidectomy（ endo group） and 78 patients received conventional open surgery（ open group）. The clinical and pathologic characteristics of patients, operative time, postoperative hospital stay time, and postoperative complications were analyzed retrospectively. Results ： The mean operating time of endo group was significantly longer than open group （86.15 ±12.54 min vs. 50.64 ±8.03 min）, the mean volume of drainage of endo group was significantly larger than open group（82.33 ±21.98ml vs. 69.60 ± 16.44ml） and the mean score of cosmetic was significantly lower than open group（ 1.05 ±0.22 vs. 3.90 ± 1.20）. operative blood loss, tumor size, the number of lymph node, the number of positive lymph node and lymph node positive rate, temporary recurrent laryngeal nerve （RLN） paresis rate and temporary hypoparathyroidism rate was no significant difference between endo group and open group. All patients were disease free during the follow-up period. Conclusion ： Transaxillary gasless endoscopic thyroidectomy is feasible, safe, and effective for PTMC. It would be considered as a new surgical method for selective PTMC patients.