改良内镜辅助甲状腺切除术联合颈侧区清扫术治疗分化型甲状腺癌临床研究

Clinical Study of Modified Endoscopic Assisted Thyroidectomy Combined with Cervical Lateral Dissection for Patients with Differentiated Thyroid Cancer

目的:探讨改良内镜辅助甲状腺切除术+颈侧区清扫术治疗分化型甲状腺癌(DTC)患者的临床效果。方法:选取分化型甲状腺癌(DTC)患者78例,其中行传统手术的38例为对照组,行改良内镜辅助甲状腺切除术+颈侧区清扫术的40例为观察组。比较2组手术时间、术中出血量、淋巴结清扫数量、疤痕长度、并发症发生率、术前、术后3个月甲状腺球蛋白(Tg)和甲状腺球蛋白抗体(TgAb)水平。结果:观察组手术时间、淋巴结清扫数量与对照组比较,差异无统计学意义(P>0.05);观察组术中出血量(36.94±4.25) mL少于对照组的(45.39±5.14) mL,疤痕长度(6.08±0.47) cm短于对照组的(13.42±0.69) cm(P<0.05);术后3个月,2组血清Tg、TgAb均较术前降低,且与对照组比较,观察组血清Tg[(6.04±2.32)vs(13.14±2.81)μg·L^-1]、TgAb[(11.75±4.63)vs(19.02±5.34) IU·mL^-1]低于对照组(P<0.05);观察组并发症发生率(2.33%)与对照组(18.60%)比较,差异无统计学意义(P>0.05)。结论:改良内镜辅助甲状腺切除术+颈侧区清扫术治疗能有效清扫淋巴结,可降低术中出血量,减小疤痕长度,调节血清Tg、TgAb水平表达,且具有安全性。

Objective: To investigate the clinical effect of modified endoscopic-assisted thyroidectomy + cervical dissection on patients with differentiated thyroid cancer(DTC). Methods: Seventy-eight patients with differentiated thyroid cancer(DTC) were selected, of which 38 patients underwent traditional surgery as the control group, and 40 patients underwent modified endoscopic assisted thyroidectomy+cervical lateral dissection as the observation group.The operation time, intraoperative blood loss, lymph node dissection, scar length, complication rate, thyroglobulin(Tg) and thyroglobulin antibody(TgAb) levels before and 3 months after operation were compared between the two groups. Results: There was no significant difference in the operation time and lymph node dissection between the observation group and the control group(P>0.05);the intraoperative blood loss(36.94±4.25) mL in the observation group was less than that in the control group(45.39±5.14) mL, the scar length(6.08±0.47) cm was shorter than the control group(13.42±0.69) cm(P<0.05);the serum Tg and TgAb of the two groups were lower than those before surgery at 3 months after operation, and the serum Tg [(6.04±2.32) vs(13.14±2.81) μg·L^-1] and TgAb [(11.75±4.63) vs(19.02±5.34) IU·mL^-1] of the observation group were lower than those of the control group(P<0.05);the incidence of complications in the observation group was 2.33% and the control group was 18.60%, and there was no significant difference between the two groups(P>0.05). Conclusion: Modified endoscopic assisted thyroidectomy and cervical dissection can effectively remove lymph nodes, reduce intraoperative blood loss, reduce scar length, and regulate the expression of serum Tg and TgAb levels, and it is safe.