腔镜手术与开放手术在治疗甲状腺微小癌的临床对比

Clinical Comparison of Laparoscopy and Open Surgery in the Treatment of Thyroid Microcarcinoma

目的研究腔镜手术与开放手术在治疗甲状腺微小癌(TMC)的临床效果。方法随机选取2019年5月—2020年5月于该院收治的104例TMC患者,根据治疗方法差异性进行分组。52例患者采取开放根治手术视为对照组;52例患者采取腔镜下根治术为治疗方案视为观察组,比较两组患者围术期指标、并发症发生率、切口美观度及1年内肿瘤复发情况。结果观察组手术时间、术中出血量、引流管留置时间、术后第1天切口引流量及住院时间均高于对照组,差异有统计学意义(t=5.842、8.120、10.637、13.759、6.058,P<0.05),但中央区淋巴结清扫数目与对照组比较,差异无统计学意义(t=0.149,P>0.05);观察组并发症发生率为9.62%。低于对照组的26.93%,差异有统计学意义(χ^(2)=5.216,P<0.05);观察组术后切口美容满意度为94.23%,高于对照组的73.08%,差异有统计学意义(χ^(2)=8.508,P<0.05);两组患者随访1年后,均未出现肿瘤复发和转移现象。结论针对TMC患者治疗,全腔镜根治术的近(中央区淋巴结清扫数目)、远期疗效(肿瘤复发、转移概率)效果和开放手术大体相等,但前者术后切口美容满意度更高,且并发症发生率少,预后安全性更高,适用于美容要求度较高的低危型病症患者。

Objective To study the clinical effects of laparoscopic surgery and open surgery in the treatment of thyroid microcarcinoma(TMC).Methods A total of 104 patients with TMC admitted to the hospital from May 2019 to May 2020 were randomly selected and divided into groups according to the difference of treatment methods.52 patients were treated as control group by open radical surgery.52 patients were treated with laparoscopic radical resection as the observation group.Perioperative indicators,incidence of complications,incision aesthetics and tumor recurrence within 1 year were compared between the two groups.Results The operative time,intraoperative blood loss,drainage tube indplacement time,incision drainage flow on the first postoperative day and length of hospital stay in the observation group were higher than those in the control group,the differences were statistically significant(t=5.842,8.120,10.637,13.759,6.058,P<0.05),but the number of dissected lymph nodes in the central region was compared with that in the control group.There was no statistically significant difference(t=0.149,P>0.05);the complication rate of observation group was 9.62%,lower than 26.93%of the control group,the difference was statistically significant(χ^(2)=5.216,P<0.05).The surgical satisfaction of the observation group was 94.23%,which was higher than that of the control group(73.08%),the difference was statistically significant(χ^(2)=8.508,P<0.05);after 1 year follow-up,no tumor recurrence or metastasis occurred in both groups.Conclusion For the treatment of patients with TMC,the near(central area lymph node dissection)and long-term curative effect(probability of tumor recurrence and metastasis)of total laparoscopic radical resection are roughly equivalent to those of open surgery.However,the former has higher satisfaction with postoperative incision cosmetics,less complication,and higher prognostic safety.It is suitable for patients with low-risk diseases with higher cosmetic requirements.