经口腔前庭入路行腔镜下甲状腺癌根治术效果探讨

Effect of Endoscopic Radical Thyroidectomy Via Oral Vestibular Approach

目的:探讨经口腔前庭入路行腔镜下甲状腺癌根治术对患者围手术期指标及切口满意度的影响。方法:回顾性分析2018年1月-2019年12月收治的96例甲状腺癌患者临床资料,根据手术方法分为观察组(经口腔前庭入路腔镜下甲状腺癌根治术,n=50)和对照组(开放性甲状腺癌根治术,n=46)。比较两组围术期指标,评估术前、术后1d时两组应激反应[C反应蛋白(CRP)、血糖、皮质醇(Cor)]、评估术后1d、术后3d疼痛情况[视觉模拟评分表(Visual analogue scale,VAS)],随访记录两组并发症情况,评估两组切口满意度[主观满意度、温哥华瘢痕评定量表(Vancouver scar scale,VSS)]。结果:观察组手术时间长于对照组,术中出血量、术后引流量、住院时间均小于对照组,差异有统计学意义(P<0.05)。两组清扫淋巴结数量比较差异无统计学意义(P>0.05)。术后1d时,两组CRP、血糖、Cor均高于术前,观察组CRP、Cor增幅小于对照组,差异有统计学意义(P<0.05)。手术前后血糖水平组间比较差异均无统计学意义(P>0.05)。术后1d、3d,观察组VAS评分均低于对照组,差异有统计学意义(P<0.05);两组术后3d VAS评分均低于术后1d,差异有统计学意义(P<0.05)。两组声音改变、下唇麻木、暂时性喉返神经损伤、切口感染征象及总并发症发生率比较差异无统计学意义(P>0.05)。术后3个月,观察组切口主观满意度总优良率高于对照组,VSS评分低于对照组,差异有统计学意义(P<0.05)。结论:经口腔前庭入路行腔镜下甲状腺癌根治术安全有效,有利于提高患者切口外观满意度。

Objective To explore the effects of endoscopic radical resection of thyroid cancer via oral vestibular approach on perioperative indicators and incision satisfaction of patients.Methods The clinical data of 96 patients with thyroid cancer admitted between January 2018 and December 2019 were retrospectively analyze,and the patients were divided into the observation group(endoscopic radical resection of thyroid cancer via transoral vestibular approach,n=50)and the control group(open radical resection of thyroid cancer,n=46).The perioperative indicators of the two groups were compared,and the stress response indexes[C-reactive protein(CRP),blood glucose,cortisol(Cor)]were evaluated in the two groups before surgery and at 1d after surgery,and the pain[Visual analogue scale(VAS)]was evaluated at 1d after surgery and at 3d after surgery,and the complications was recorded in the two groups at follow-up,and the incision satisfaction[subjective satisfaction,Vancouver scar scale(VSS)]was evaluated in the two groups.Results The operative time in the observation group was longer than that in the control group,the difference was statistically significant(P<0.05).And the intraoperative blood loss,postoperative drainage volume and hospital stay in the observation group were less than those in the control group(P<0.05).There was no statistically significant difference in the number of dissectedlymph nodes between the two groups(P>0.05).At 1d after surgery,the CRP,blood glucoseand Cor in the two groups were higher than those before surgery(P<0.05).And the increases of CRP and Cor in the observation group were less than those in the control group(P<0.05).There was no statistically significant difference in the postoperative blood glucose between the two groups(P>0.05).The VAS scores of the observation group were lower than those of the control group at 1d and 3d after operation(P<0.05).The VAS score at 3d after operation was lower than that at 1d after operation(P<0.05).There was no significant difference in sound changes,lower lip numbness,temporary recurrent laryngeal nerve injury,incision infection and the incidence of total complications between the two groups(P>0.05).Three months after operation,the overall excellent and good rate of subjective satisfaction of incision in the observation group was higher than that in the control group,and the VSS score was lower than that in the control group(P<0.05).Conclusion Endoscopic radical resection of thyroid cancer via transoral vestibular approach is safe and effective in the treatment of thyroid cancer,and it is conducive to improving the satisfaction of incision appearance.