改良无充气经腋窝腔镜甲状腺手术治疗甲状腺微小乳头状癌的疗效分析

Efficacy of the modified gasless unilateral axillary approach endoscopic thyroid surgery in the treatment of papillary thyroid microcarcinoma

目的本研究旨在探讨改良无充气经腋窝腔镜(modified gasless unilateral axillary approach,MGUAA)甲状腺手术治疗甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)的有效性和安全性。方法回顾性分析桐乡市第一人民医院甲状腺乳腺外科2019年1月至2019年12月采用MGUAA单侧甲状腺癌根治术(腔镜组,n=41)与采用传统开放单侧甲状腺癌根治术(开放组,n=49)的PTMC患者(cT1N0M0,cI期,8th,2017 AJCC)共90例,男14例,女76例,平均年龄(42.1±12.0)岁。两组在中央区淋巴结清扫有效性、手术时间、手术类型、引流量、住院时间、相关并发症、术后颈前及腋下疼痛、美容满意度等方面进行比较。采用SPSS 25.0统计软件进行分析,计量资料采用平均值±标准差(±s)表示,组间比较采用t检验,构成比或率的比较采用χ^(2)检验。结果腔镜组在年龄(35.0±8.6)岁和手术出血量(12.3±7.3)ml方面显著低于开放组年龄(48.1±11.1)岁和手术出血量(16.1±4.3)ml(P<0.01);在手术时间(99.1±19.5)min、术后引流量(221.4±67.9)ml和术后置管时间(5.0±0.8)d方面显著高于开放组手术时间(70.6±17.8)min、术后引流量(98.3±63.7)ml及术后置管时间(3.8±1.0)d(P<0.01)。两组间在中央区淋巴结清扫个数和总住院时间上差异无统计学意义(P>0.05)。在手术并发症方面,两组在暂时性喉返神经损伤、术后血肿、术后感染和淋巴漏的发生率上差异无统计学意义(P>0.05)。腔镜组在避免术后颈前吞咽不适和颈前区疼痛,切口满意度评估上较开放组具有显著优势[(0.0%比28.6%)、(14.6%比71.4%)、(1.1±0.3)分比(2.4±0.5)分(P<0.01)],而在手术侧腋窝区疼痛上劣于开放组(P<0.01)。结论对于经选择的PTMC患者,MGUAA单侧甲状腺癌根治术是一种可行、安全且美容效果较好的手术方式。

Objective To investigate the efficacy and safety of the modified gasless unilateral axillary approach(MGUAA)endoscopic thyroid surgery in treatment of papillary thyroid microcarcinoma(PTMC).Methods From Jan.2019 to Dec.2019,90 patients receiving PTMC(cT1N0M0,cI stage,8th,2017 AJCC)therapy by modified gasless unilateral axillary approach endoscopic thyroid surgery(MGUAA group,n=41),and conventional open thyroid surgery(OS group,n=49)were retrospectively analyzed.Ninety patients were enrolled in the study,including 14 males and 76 females,with the mean age(42.1±12.0)years.The effectiveness of central lymph node dissection(CLND),the operation time,the types of operation,the amount of drainage,the duration of hospital stay,the related complications,the postoperative pain of neck and axillary and the cosmetic satisfaction were compared between the two groups.SPSS 25.0 statistical software was used for statistical analysis,the measurement data was expressed by±s,paired t test was used to compare the measurement data between groups,and Chi-square test was used to campare the count date between groups.Results The mean age(35.0±8.6)years and the amount of surgical bleeding(12.3±7.3)ml in the MGUAA group were significantly lower than those(48.1±11.1)years and(16.1±4.3)ml in the OS group(P<0.01),while the mean operation time(99.1±19.5)min,the mean amount of drainage(221.4±67.9)ml and the postoperative drainage tube placement time(5.0±0.8)days were significantly higher than those of(70.6±17.8)min,(98.3±63.7)ml and(3.8±1.0)days in the MGUAA(P<0.01).There was no significant difference in the number of lymph nodes of CLND or the duration of hospital stay between the two groups(P>0.05).In terms of surgical complications,the transient recurrent laryngeal nerve injury,the postoperative hematoma,the postoperative infection,and the lymphatic leakage had no significant difference between the two groups(P>0.05).The MGUAA group had significant advantages in avoiding the postoperative dysphagia in front of neck,the postoperative pain of neck,and cosmetic satisfaction over the OS group[(0.0%vs 28.6%),(14.6%vs 71.4%),(1.1±0.3)score vs(2.4±0.5)score(P<0.01)].Whereas in axillary area pain on the surgical side,the MGUAA group was inferior to the OS group(P<0.01).Conclusion The modified gasless unilateral axillary approach endoscopic thyroid surgery is a feasible,safe and cosmetically operation for PTMC(cT1N0M0,cI stage,8th,2017 AJCC).