腔镜辅助与开放颈侧区淋巴结清扫术在甲状腺乳头状癌治疗中的比较研究

Comparative study of surgical outcomes between video-assisted and open lateral neck dissection for papillary thyroid carcinoma

目的比较分析腔镜辅助与开放颈侧区淋巴结清扫术在甲状腺乳头状癌治疗中的安全性、有效性及美容微创疗效。方法回顾性分析2015年6月至2019年12月期间在笔者所在医院接受手术治疗的甲状腺乳头状癌患者临床资料,最终纳入研究的腔镜辅助组(n=47)与开放组(n=47)共94例,观察比较2组的围手术期情况及美容微创评价结果。结果 2组患者的颈侧区淋巴结转移数、手术时间、术后引流量、术后引流管拔除时间和术后住院时间的差异均无统计学意义(P>0.05);腔镜辅助组在颈侧区淋巴结清扫数、术中出血量、颈部感觉异常程度和美容满意程度方面较开放组具有明显优势(P<0.05)。腔镜辅助组与开放组手术并发症发生率差异无统计学意义(P>0.05)。结论腔镜辅助手术在不影响手术安全性和有效性的前提下较开放手术具有更好的美容效果及较小的颈部创伤,值得临床应用推广。

Objective To explore the safety,effectiveness and minimally invasive cosmetic evaluation results of treatment for papillary thyroid carcinoma(PTC)by video-assisted lateral neck dissection(VALND)or open lateral neck dissection(OLND).Methods The clinical data of patients with PTC who received surgical treatment in the Affiliated Hospital of Nanjing University Medical School from June 2015 to December 2019 were retrospectively analyzed.The data of 94 cases in the VALND group(n=47)and the OLND group(n=47)were finally included in this study,and perioperative conditions and minimally invasive cosmetic evaluation results between the two groups were studied.Results There were no statistical differences of lateral metastatic lymph node numbers,operative time,postoperative drainage volume,drainage tube removal time and postoperative hospitalization days between the two groups(P>0.05).The lateral retrieved lymph node numbers,intraoperative blood loss,the degree of cervical paresthesia and the degree of cosmetic satisfaction in the VALND group were significantly better than those in the OLND group(P<0.05).There was no significant difference of surgical complications between the two groups(P>0.05).Conclusion Without sacrificing surgical safety and effectiveness,VALND has better cosmetic effect and less neck trauma than OLND,which is worthy of clinical application and promotion.