全乳晕腔镜途径与传统开放手术治疗T_1期乳头状甲状腺癌的疗效比较

Efficacy comparison of endoscopic thyroidectomy via bilateral areolar approach and conventional open thyroidectomy in treatment of T_1 papillary thyroid cancer

目的:比较全乳晕腔镜下与传统开放手术治疗T_1期甲状腺乳头状癌的临床效果。方法:回顾性分析2016年1月—2017年12月行全乳晕入路腔镜甲状腺手术56例T_1期甲状腺乳头状癌患者(腔镜组)与行传统开放甲状腺手术的56例T_1期甲状腺乳头状癌患者(开放组)的临床资料。结果:两组术前一般资料和手术方式比较差异无统计学意义(均P>0.05)。腔镜组平均手术时间高于开放组(132.1minvs.96.7min,P<0.05),两组在术中出血量、清扫淋巴结数和转移阳性率、术后并发症方面无统计学差异(均P>0.05)。腔镜组中,癌结节直径<1cm的患者与癌结节直径1~2cm的患者间比较,后者手术时间和术后暂时性低钙血症发生率方面明显高于前者(P<0.05),但两者术中出血量、中央区清扫淋巴结数及阳性率、术后并发症均无明显差异(均P>0.05)。术后随访腔镜组与开放组均无复发和转移征象。结论:全乳晕腔镜途径下手术治疗T1期甲状腺乳头状癌是安全可行的,与传统甲状腺手术具有相似的临床疗效。

Objective： To compare the clinical effects between endoscopic thyroidectomy via bilateral areolar approach and conventional open thyroidectomy in treatment of T1 papillary thyroid cancer（PTC）.Methods： The clinical data of 56 patients with T1 PTC undergoing endoscopic thyroidectomy via bilateral areolar approach（endoscopic group） and 56 patients with T1 PTC undergoing conventional open surgery（open surgery group） from January 2016 to December 2017 were retrospectively analyzed.Results： There were no significant differences in preoperative data and surgical procedures between the two groups（all P〉0.05）. The average operative time in endoscopic group was significantly longer than that in open surgery group（132.1 min vs. 96.7 min, P〈0.05）, but no significant differences were noted in intraoperative blood loss, the number of dissected lymph nodes, rate of positive lymph nodes and incidence of postoperative complications between the two groups（all P〉0.05）. In endoscopic group, the operative time and incidence of postoperative temporary hypocalcemia were increased in patients with the diameter of lesion less than 1 cm compared with those with the diameter of lesion from 1 to 2 cm（both P〈0.05）, but no significant differences were seen in intraoperative blood loss, number of dissected lymph nodes and rate of positive lymph nodes and incidence of postoperative complications between them（all P〉0.05）. No signs of recurrence or metastasis were noted in both groups during follow-up.Conclusion： Endoscopic thyroidectomy via bilateral areolar approach is safe and feasible for T1 PTC, and it also has similar clinical efficacy to that of open thyroidectomy.