经腋乳入路与胸乳入路行腔镜甲状腺癌切除术的比较研究

A comparative study of axillary-breast approach and chest-breast approach in endoscopic thyroidectomy for thyroid carcinoma

目的:通过与胸乳入路腔镜甲状腺癌切除术对比,探讨腋乳入路腔镜甲状腺癌切除术的临床疗效及安全性。方法:回顾分析2019年1月1日至2020年1月1日行腔镜甲状腺癌切除术患者的临床资料,其中经腋乳入路、胸乳入路各40例,比较两组围手术期相关指标、并发症。结果:腋乳入路组与胸乳入路组术后住院时间[(4.6±1.2)d vs.(4.9±1.4)d,P=0.307]、淋巴结清扫数量[(4.5±3.2)vs.(3.6±2.7),P=0.178]、并发症发生率(7.5%vs.12.5%,P=0.709)差异无统计学意义,手术时间[(156.3±30.2)min vs.(172.6±35.3)min,P=0.029]、术中出血量[(15.8±6.5)mL vs.(23.4±8.6)mL,P<0.001]、术后总引流量[(107.9±34.7)mL vs.(124.6±30.5)mL,P=0.025]差异有统计学意义。两组术后随访1年,无局部复发、淋巴结转移及远处转移。结论:腋乳入路切口隐蔽,对于单侧甲状腺癌是安全、有效、可推荐的手术路径。

Objective:To explore the clinical efficacy and safety of endoscopic thyroidectomy via axillary-breast approach by comparing with endoscopic thyroidectomy via chest-breast approach.Methods:From Jan.1,2019 to Jan.1,2020,the patients with unilateral thyroid carcinoma were divided into axillary-breast approach group and chest-breast approach group,with 40 cases in each group.The perioperative indicators and complications were compared between the two groups.Results:The operation time of axillary-breast approach group and chest-breast approach group were(156.3±30.2)min and(172.6±35.3)min respectively(P=0.029).The intraoperative blood loss of the two groups were(15.8±6.5)mL vs.(23.4±8.6)mL respectively(P<0.001).The postoperative hospital stay of the two groups were(4.6±1.2)d and(4.9±1.4)d respectively(P=0.307).The total postoperative drainage of the two groups were(107.9±34.7)mL and(124.6±30.5)mL respectively(P=0.025).The number of lymph node dissection of the two groups were(4.5±3.2)and(3.6±2.7)respectively(P=0.178).The incidence of complications of the two groups were 7.5%and 12.5%respectively(P=0.709).There was no local recurrence,lymph node metastasis or distant metastasis in the two groups one year after operation.Conclusions:The incision of the axillary-breast approach is concealed,for unilateral thyroid cancer,it is a safe,effective and recommended surgical approach.