完全经乳晕路径腔镜手术治疗甲状腺乳头状癌的临床效果

Clinical effect of total endoscopic surgery via areola approach for papillary thyroid carcinoma

目的 通过完全经乳晕入路行腔镜手术（ETE）治疗甲状腺乳头状癌（PTC）,评估其可行性及治疗效果.方法 回顾分析2013年1月至2016年1月137位甲状腺乳头状癌患者临床资料,根据患者所行手术方式进行分组.对比两组患者年龄、性别、术后疼痛、术中出血、术后住院时间、中央区淋巴结转移数目等临床病理特征.结果 纳入标准的137例患者中,79例患者选择腔镜手术,78例完成腔镜手术（腔镜组）,1例因术中出血导致腔镜术中转开放手术;58例完成开放手术.两组性别、拔管时间、术后住院时间、阳性淋巴结转移数、喉返神经损伤、永久性甲状旁腺功能低下差异均无统计学意义（均P＞0.05）.腔镜组的平均年龄小于开放组（t=-4.299,P=0.000）,腔镜组手术操作时间较开放组长（t=8.162,P=0.000）,腔镜组术中出血量（t=2.862,P=0.005）和术后引流量（t=9.539,P=0.000）多于开放组,腔镜组切口满意度[（9.4±0.5）分比（5.4±1.0）分,t=30.142,P=0.000]好于开放组.腔镜组皮下积液或瘀斑较开放组发生率高（χ2=13.482,P=0.000）.两组均无喉上神经、窒息和感染发生.随访均至少1年,均无发现肿瘤局部复发及转移.结论完全腔镜手术治疗无颈侧区淋巴结转移的PTC是安全、有效的,其美容效果显著.

Objective To evaluate the feasibility and effects of endoscopic thyroidectomy（ETE） for papillary thyroid carcinoma（PTC）.Methods A total of 137 patients with PTC were enrolled from January 2013 to January 2016.The patients were divided into two groups depended on different surgical approaches.The patients＇ characteristics,such as age,gender,pain,intraoperative blood loss,hospitalization,central lymph node metastasis etc were retrospectively analyzed in the two groups.Results In the study,78 patients performed ETE,and 58 performed COT.There was one case converted to open surgery from ETE due to intraoperative bleeding.The clinicopathological characteristics and operative complications between the two groups had no significant differences,such as gender,time of drainage,postoperative hospitalized days,positive lymph node metastasis,injury of recurrent laryngeal nerve,permanent injury of parathyroid glands.The age of patients was younger in ETE（t=-4.299,P=0.000）.The drainage content（t=9.539,P=0.000）,intraoperative blood loss（t=2.862,P=0.005） and subcutaneous ecchymosis （χ2=13.482,P=0.000） were found more in the ETE.ETE required a longer operative time（t=8.162,P=0.000）.However,ETE provided better cosmetic outcomes than COT [（9.4±0.5）points vs.（5.4±1.0）points,t=30.142,P=0.000].No clinical recurrence and metastasis occurred for at least one-year follow-up.Conclusion With excellent cosmetic results,ETE is a feasible and safe operation for patients with PTC without metastasis to lateral cervical lymph nodes.