三种腔镜路径在甲状腺癌根治术中的应用效果

Application effect of three laparoscopic paths in radical resection of thyroid cancer

目的探讨胸乳路径腔镜手术、腋乳路径腔镜手术与无充气腋窝路径腔镜手术在单侧甲状腺乳头状癌根治术中的应用效果.方法选择2015年7月~2018年6月于我科行完全腔镜下单侧甲状腺癌根治术患者106例,根据治疗方法不同分为三组,其中行胸乳路径腔镜甲状腺乳头状癌根治术22例(胸乳组),行腋乳路径腔镜甲状腺乳头状癌根治术29例(腋乳组),行无充气腋窝路径腔镜甲状腺乳头状癌根治术55例(腋窝组).观察比较三组患者术中情况及术后并发症、患者满意度情况.结果胸乳组手术时间[(103.86±21.38) min]与腋乳组[(98.10±18.73)min]比较,差异无统计学意义(P>0.05),但两组手术时间均显著短于腋窝组的(135.91±31.62)min,差异有统计学意义(P<0.05).胸乳组术后引流量[(128.50±22.35) mL]与腋窝组[(121.09±19.28)mL]比较,差异无统计学意义(P>0.05),但两组术后引流量均显著多于腋乳组的[(82.93±17.56)mL],差异有统计学意义(P<0.05).胸乳组引流管留置时间[(5.45±1.01)d]与腋乳组[(5.50±1.26)d]比较,差异无统计学意义(P>0.05),但两组引流管留置时间均显著短于腋窝组的(7.24±1.70)d,差异有统计学意义(P<0.05).三组患者术中出血量、住院天数、喉返旁淋巴结清扫数目及其阳性数目比较,差异无统计学意义(P>0.05).三组患者均未发生严重手术并发症,均对手术有较高满意度,其满意度比较,差异无统计学意义(P>0.05).结论三种腔镜路径甲状腺癌根治术各有特点,且安全可行,患者满意度较高,临床上可根据患者情况选择合适的术式;术后加强各种并发症的观察与处理,同时指导患者做好早期功能锻炼,能有效减轻手术并发症,有利于患者早日康复.

Objective To investigate the application effect of laparoscopic surgery via chest-breast approach, laparoscopic surgery via axillary breast path and laparoscopic surgery via non-inflated axillary in theradical resection of unilateral thyroid papillary carcinoma. Methods A total of 106 patients with unilateral thyroidectomy under complete endoscopy from July 2015 to June 2018 were selected and divided into three groups according to different treatment methods. And 22 cases of thyroid papillary carcinoma who underwent chest-breast endoscopic laparoscopic radical surgery(chest-breast group), 29 cases of thyroid papillary carcinoma who underwent laparoscopic radical surgery via axillary breast path(axillary breast group), 55 cases of thyroid papillary carcinoma who underwent laparoscopic radical surgery via non-inflated axillary(axillary group). The operation time, postoperative drainage volume and indwelling time of drainage tube were compared among the three groups. The intraoperative bleeding volume, average hospitalization days, number of paralaryngeal lymph node dissection and its positive number, postoperative complications and patient satisfaction were observed among the three groups. Results There was no significant difference in time-consuming between the chest-breast group [(103.86±21.38) min] and the axillary-breast group [(98.10±18.73) min](P>0.05), which was significantly shorter than (135.91±31.62) min in the non-inflated axillary group,(P<0.05). There was no significant difference in the postoperative drainage volume between chest-breast group[(128.50±22.35) mL] and the non-inflated axillary group [(121.09±19.28) mL](P>0.05), which was significantly more than that of the axillary-breast group (82.93±17.56) mL,(P<0.05). There was no significant difference in the drainage tube indwelling time between chest-breast group [(5.45±1.01) d] and the axillary-breast group [(5.50±1.26) d](P>0.05), which was significantly shorter than the non-inflated axillarygroup (7.24±1.70) d (P<0.05). There were no significant differences in the intraoperative blood loss, the average length of hospital stay, the number of lymph node dissections and the number of positive segments between three kinds of endoscopic path (P>0.05). There were no serious surgical complications occurred, and the surgical effect were satisfactory in the three groups. Conclusion Three kinds of laparoscopic radical thyroid cancer surgery are safe and feasible, which have concealed incision, and with high patient satisfaction. Strengthening the observation and treatment of various complications after operation and guiding patients to perform early functional exercise can effectively reduce the complications of surgery and facilitate the early recovery of patients.