改良Miccoli腔镜辅助颈侧区清扫术与传统开放手术治疗分化型甲状腺癌的疗效对比分析

Comparative effectiveness analysis of modified Miccoli endoscopic assisted neck lateral dissection and traditional open surgery for differentiated thyroid cancer

目的:比较分析改良Miccoli腔镜辅助颈侧区清扫术与传统开放颈淋巴结清扫术治疗分化型甲状腺癌的临床疗效。方法:回顾分析2017年1月至2018年11月手术治疗的71例分化型甲状腺癌患者的临床资料,分为腔镜组(n=34)与开放组(n=37),观察两组术中情况及围手术期并发症等。结果:两组患者手术时间、术后引流量、住院时间、清扫淋巴结总数及阳性数量差异均无统计学意义(P>0.05),腔镜组术中出血量、术后疤痕长度、术后疼痛发生率优于开放组(P<0.05);腔镜组切口愈合不良、皮瓣坏死、面部肿胀及乳糜瘘等术后并发症总发生率为14.7%,开放组为18.9%,两组差异无统计学意义(P>0.05)。结论:改良Miccoli腔镜辅助颈侧区清扫术与传统开放手术均安全、可靠,且颈部遗留疤痕更小,更为美观,术后疼痛情况明显改善,值得临床推广。

Objective: To compare and analyze the clinical efficacy of modified Miccoli endoscopic assisted cervical dissection and traditional open cervical lymph node dissection in the treatment of differentiated thyroid cancer. Methods: A retrospective analysis was performed on clinical data of 71 patients with differentiated thyroid cancer who underwent surgery from Jan.2017 to Nov.2018.They were divided into endoscopic group ( n =34) and open group ( n =37).Intraoperative conditions and perioperative complications of the two groups were observed. Results: There was no significant difference in the operation time,postoperative drainage,hospitalization time,total number or positive number of lymph nodes between the two groups( P >0.05).The amount of bleeding,the length of postoperative scar and the incidence of postoperative pain in the endoscopic group were better than those in the open group ( P <0.05);the total incidence of postoperative complications such as poor healing,skin flap necrosis,facial swelling and chylous fistula in the endoscopic group was 14.7%,and in the open group was 18.9%,there was no significant difference between the two groups ( P >0.05). Conclusions: Modified Miccoli endoscopic assisted neck lateral dissection is as safe and reliable as traditional open surgery,the scar left in the neck is smaller and more cosmetic,the postoperative pain is obviously improved,this procedure is worthy of clinical promotion.