经口腔前庭入路腔镜甲状腺腺叶切除联合中央区淋巴结清扫术的临床应用

Clinical application of transoral endoscopic thyroid lobectomy vestibular approach combined with central lymph node dissection

目的探讨经口腔前庭入路腔镜甲状腺腺叶切除联合中央区淋巴结清扫术治疗甲状腺乳头状癌的临床效果。方法纳入76例甲状腺乳头状癌患者进行前瞻性研究。采用随机数字表法将患者分为对照组和观察组,每组38例。2组患者均行腔镜甲状腺腺叶切除联合中央区淋巴结清扫术,对照组患者采用经腋窝入路,观察组患者采用经口腔前庭入路。比较2组患者围术期相关指标、术后并发症发生情况、手术前后甲状旁腺素(PTH)和血钙水平、切口美观满意度及术后复发和转移情况。结果观察组患者的手术时间短于对照组,术后引流量低于对照组,差异有统计学意义(P<0.05);而2组患者的淋巴结清扫总数、术中出血量、住院时间及术后并发症发生率比较,差异无统计学意义(P>0.05)。2组患者手术前后PTH及血钙水平比较,差异均无统计学意义(P>0.05);2组术后血钙水平均先降低后又逐渐回升,其中术后1 d血钙水平较术前降低(P<0.05),术后3 d血钙水平较术后1 d升高(P<0.05)。随访期间,观察组的切口美观满意度显著高于对照组(P<0.05);2组均无复发及转移病例。结论经口腔前庭入路腔镜甲状腺腺叶切除联合中央区淋巴结清扫术具有手术时间短、切口美观满意度高等优势,不仅满足了患者完全无瘢痕的美容要求,还可保证良好的手术效果。

Objective To investigate the clinical effect of transoral endoscopic thyroid lobectomy vestibular approach combined with central lymph node dissection in the treatment of papillary thyroid carcinoma.Methods A total of 76 patients with papillary thyroid carcinoma were enrolled in this prospective study.The patients were divided into the control group and the observation group by random number table method,with 38 cases in each group.Patients in the two groups were all treated with endoscopic thyroid lobectomy combined with central lymph node dissection,the control group adopted transaxillary approach,and the observation group adopted transoral vestibular approach.The perioperative related indexes,postoperative complications,levels of parathyroid hormone(PTH)and serum calcium before and after operation,aesthetic satisfaction of incision and postoperative recurrence and metastasis were compared between the two groups.Results The operation time of the observation group was shorter than that of the control group,the postoperative drainage volume was lower than that of the control group,the differences were statistically significant(P<0.05);there was no significant difference in the total number of lymph node dissection,intraoperative blood loss,hospital stay or postoperative complications between the two groups(P>0.05).There was no significant difference in the levels of PTH or serum calcium between the two groups before and after operation(P>0.05);the levels of serum calcium decreased at first and then increased gradually after operation,the levels of serum calcium 1 day after operation decreased significantly compared with those before operation in the two groups(P<0.05),and the levels of serum calcium 3 days after operation increased significantly compared with those 1 day after operation in the two groups(P<0.05).During the follow-up period,the aesthetic satisfaction of incision in the observation group was significantly higher than that in the control group(P<0.05);and there was no recurrence or metastasis in the two groups.Conclusion The transoral endoscopic thyroid lobectomy vestibular approach combined with central lymph node dissection has the advantages of shorter operation time,higher aesthetic satisfaction of incision and so on,which can not only meet the scarless requirements of patients,but also ensure good surgical effect.