经口腔前庭入路与全乳晕入路腔镜单侧甲状腺癌手术的临床疗效比较

Clinical comparison of the oral vestibular approach and complete areola approach for endoscopic thyroidectomy of unilateral thyroid carcinoma

目的:探讨经口腔前庭入路与全乳晕入路腔镜甲状腺手术治疗单侧甲状腺癌的临床疗效。方法:回顾分析2017年1月至2018年3月行腔镜单侧甲状腺癌手术的88例患者的临床资料,根据手术方式分为经口腔前庭入路腔镜甲状腺手术组(观察组,n=46)与全乳晕入路腔镜甲状腺手术组(对照组,n=42),对比两组术中、术后相关情况。结果:两组年龄、肿瘤最大直径差异无统计学意义(P>0.05)。两组患者均在腔镜下完成手术,两组手术时间、术中出血量、中央区淋巴结清扫数量、住院时间差异均无统计学意义(P>0.05)。观察组术中发生1例CO2气体栓塞,1例暂时性喉返神经损伤;对照组发生1例皮肤烫伤,1例术后出血,1例永久性喉返神经损伤;两组总并发症发生率差异无统计学意义(P>0.05),但观察组患者手术满意度高于对照组,差异有统计学意义(P<0.001)。结论:与全乳晕入路相比,经口腔前庭入路腔镜甲状腺手术治疗单侧甲状腺癌美容效果更好,患者满意度高,值得临床应用与推广。

Objective:To compare the clinical efficacy of the oral vestibular approach and complete areola approach for endoscopic thyroidectomy of unilateral thyroid carcinoma.Methods:The clinical data of 88 patients with unilateral thyroid carcinoma who undergoing endoscopic surgery from Jan.2017 to Mar.2018 were retrospectively analyzed.According to the surgical methods,the patients were divided into the oral vestibular approach group(n=46)and complete areola approach group(n=42).The main clinical variables between the two groups were compared.Results:There was no obvious difference in age or maximum diameter of tumor between the two groups(P>0.05).Endoscopic surgery was completed in all patients.There were no obvious differences between the two groups in the surgery time,intraoperative blood loss,the number of central lymph node dissected or hospital stay(P>0.05).One case of CO2 gas embolism and one case of temporary recurrent laryngeal nerve injury occurred in the oral vestibular approach group.One case of skin burn,one case of postoperative hemorrhage,and one case of permanent recurrent laryngeal nerve injury occurred in the complete areola approach group,there was no significant difference in total complications between the two groups(P>0.05).However,patients with oral vestibular approach had significantly higher satisfaction with surgery than the complete areola approach group(P<0.001).Conclusions:Compared with the complete areola approach,the oral vestibular approach endoscopic thyroidectomy of unilateral thyroid carcinoma has better cosmetic effect and better patient satisfaction,is worthy of clinical application and promotion.