腔镜辅助手术与开放手术治疗cN0期甲状腺乳头状癌的对比

A comparative study of video-assisted thyroidectomy and open thyroid surgery for cN0 papillary thyroid carcinoma

目的:比较胸骨切迹入路腔镜辅助下甲状腺手术(minimally invasive video-assisted thyroidectomy,MIVAT)与传统开放手术(open thyroid surgery,OTS)治疗临床淋巴结阴性(clinically node-negative,cN0)甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的彻底性、安全性以及术后美容效果的差异。方法:收集2012年1月至2017年12月间复旦大学附属肿瘤医院行胸骨切迹入路MIVAT的80例cN0期PTC患者,并根据1:2比例使用随机数法抽取160例同期行OTS的PTC患者。患者手术方式为腺叶切除/全甲切除术+预防性中央区淋巴结清扫术。采用χ~2检验、Kaplan-Meier生存分析与Log-rank检验对比两种手术方式的差异。结果:MIVAT组的平均手术时间长于OTS组(P=0.003),但住院时间明显缩短(P<0.001)。手术疗效方面,MIVAT组与OTS组患者的术后复发率、淋巴结清扫数目以及淋巴结转移数目的差异均无统计学意义(均P>0.05)。手术安全性方面,两种术式术后发生喉返神经损伤、术后血肿和感染等并发症的发生率相近(均P>0.05)。两组患者术后的改良版温哥华瘢痕量表(Vancouver scar scale,VSS)评分亦无显著性差异(P=0.288),但MIVAT组相比OTS组可以显著缩短颈部瘢痕长度(P<0.001)。结论:对于cN0期PTC而言,MIVAT在手术的疗效、安全性上与OTS无明显区别,尽管MIVAT的改良VSS瘢痕评分与OTS类似,但胸骨切迹入路MIVAT可以显著减少颈部切口长度,具有一定的美容效果,同时由于切口位置更低,容易遮盖,美容效果更好。因此,经胸骨切迹入路MI-VAT可在临床实践中进一步推广。

Objective: To compare the effectiveness and safety of and the presence of postoperative scars in minimally invasive video-assisted thyroidectomy(MIVAT) through the suprasternal notch approach and conventional open thyroid surgery(OTS) in patients with clinically node-negative(cN0) papillary thyroid carcinoma(PTC). Methods: We enrolled 80 patients with cN0 PTC who underwent MIVAT through the suprasternal notch approach at Fudan University Shanghai Cancer Center between January 2012 and December 2017.A total of 160 patients with cN0 PTC who underwent OTS at our hospital were selected using the random number table method in a 1 :2 ratio. The patients underwent lobectomy or total thyroidectomy and prophylactic central neck dissection. The Chi-square test, Kaplan-Meier survival analysis, and Log-rank test were used to determine the differences between the two surgical procedures. Results:The mean operative time in the MIVAT group was longer than that in the OTS group(P=0.003). The length of hospital stay in the MIVAT group was significantly shorter than that in the OTS group(P<0.001). There was no significant difference in the postoperative recurrence rate, the number of dissected lymph nodes and positive lymph nodes between the two groups(P>0.05). The incidence of complications such as recurrent laryngeal nerve injury, postoperative hematoma, and infection was comparable between the two groups(P>0.05). Furthermore, there was no significant difference in the modified Vancouver scar scale(VSS) score between the two groups;however, the length of the cervical scar in the MIVAT group was significantly reduced compared to that in the OTS group(P<0.001). Conclusions: There is no significant difference in the effectiveness and safety of MIVAT and OTS in patients with cN0 PTC. Although the modified VSS scores of the two procedures are comparable, the use of MIVAT significantly reduces the length of the neck incision. Therefore, MIVAT can provide a better cosmetic effect and consequently be widely used in clinical practice.