经口腔前庭入路腔镜甲状腺切除术在甲状腺微小乳头状癌中的应用

Application of transoral endoscopic thyroidectomy via vestibular approach in papillary thyroid microcarcinoma

目的:探讨经口腔前庭入路腔镜甲状腺切除术在甲状腺微小乳头状癌中应用的安全性、可行性及临床效果。方法:回顾性分析2016年1月至2020年1月蚌埠医学院第一附属医院肿瘤外科收治的45例经病理确诊的甲状腺微小乳头状癌患者的临床资料,所有患者均采用腔镜甲状腺切除术进行治疗,其中行经口腔前庭入路15例为经口组,经胸乳入路30例为经胸乳组,比较2组患者围术期资料及随访情况等。结果:2组患者在术中出血量、术后住院时间、中央区淋巴结清扫数目方面比较,差异无统计学意义(P>0.05);经口组患者术后第1天引流量、颈部VAS评分显著低于经胸乳组(P<0.05),但手术时间显著多于经胸乳组(P<0.05)。2组患者术后并发症比较,差异无统计学意义(P>0.05)。2组患者术后至少随访6个月,经口组患者美容满意度评分高于经胸乳组(P<0.05),且均未见肿瘤复发与转移。结论:经口腔前庭入路腔镜甲状腺切除术治疗甲状腺微小乳头状癌手术安全、可行及临床效果良好,且有较佳的美容效果。

Objective:To explore the safety,feasibility and clinical effects of transoral endoscopic thyroidectomy via vestibular approach in papillary thyroid microcarcinoma.Method:The clinical data of 45 patients with papillary thyroid carcinoma who were admitted to our hospital from Jan 2016 to Jan 2020 were retrospectively analyzed.Fifteen patients were treated with transoral endoscopic thyroidectomy via vestibular approach,and 30 patients were treated with endoscopic thyroidectomy via chest and breast approach.The perioperative data and follow-up status of the two groups were compared.Results:There was no statistically significant difference between the two groups in terms of intraoperative blood loss,postoperative hospital stay,and the number of lymph node dissections in the central area(P>0.05).In the oral group,the drainage and neck VAS score on the first day after surgery was significantly lower than those in the chest and breast group(P<0.05),but the operation time was significantly longer than that in the chest and breast group(P<0.05).There was no significant difference in postoperative complications between the two groups(P>0.05).The patients were followed up for at least 6 months after the operation.The cosmetic satisfaction score of the oral group was higher than that of the chest and breast group(P<0.05).And there was no tumor recurrence or metastasis in the two groups.Conclusion:Application of transoral endoscopic thyroidectomy via vestibular approach in the treatment of papillary thyroid carcinoma is safe,feasible and clinically effective,and has better cosmetic effects.