经口联合颏下腔镜与开放甲状腺手术的对比研究

Comparison of Transoral Endoscopic Thyroidectomy Via Submental and Vestibular Approach Versus Open Thyroidectomy

目的比较经口联合颏下入路腔镜与开放甲状腺切除术治疗甲状腺乳头状癌的安全性及疗效。方法分析2019年1月至2021年1月103例甲状腺乳头状癌手术患者的资料,根据手术方式分为经口联合颏下入路腔镜组(n=27)和开放手术组(n=76)。比较2组患者手术指标(包括手术耗时、术中失血量、术后引流量、术后住院时间、淋巴结清扫总数、阳性淋巴结比例)、术后并发症情况(喉返神经损伤、甲状旁腺功能减低、手术部位感染以及下颏部位感觉减退)及术后24 h疼痛程度(VAS评分)、美容效果和满意度。结果与开放手术组相比,经口联合颏下入路腔镜组患者手术耗时较长,但清扫的淋巴结总数更多(P<0.05);2组间术中出血量、术后引流量和术后住院时间比较差异无统计学意义(均P>0.05)。2组患者术后住院期间喉返神经损伤、甲状旁腺功能减低、手术部位感染以及下颏部位感觉减退发生率比较差异无统计学意义(均P>0.05),术后半年随访时2组无一例上述并发症发生;经口联合颏下入路腔镜组出现2例暂时性喉返神经损伤和1例暂时性甲状旁腺功能减低,未发生手术部位感染及下颏部位感觉减退。经口联合颏下入路腔镜组患者术后24 h疼痛VAS评分与开放手术组比较差异无统计学意义(P>0.05),患者满意度和美容效果评分均显著高于开放手术组(均P<0.05)。结论经口联合颏下入路腔镜甲状腺手术安全性不劣于传统开放手术,且中央区淋巴结清扫更为彻底,适合于对美容有较高需求的早期甲状腺癌患者。

Objective To compare the safety and efficacy of transoral endoscopic thyroidectomy via submental and vestibular approach(TOETSMVA)and open thyroidectomy in papillary thyroid carcinoma.Methods Data of 103 patients treated between January 2019 to January 2021 for papillary thyroid carcinoma were analyzed.These patients were divided into TOETSMVA group(n=27)and open thyroidectomy group(n=76).Surgical indicators(operation time,intraoperative blood loss,postoperative drainage volume,postoperative hospital stay,total number of lymph nodes dissected and percentage of positive lymph nodes),postoperative complications(recurrent laryngeal nerve injury,hypoparathyroidism,surgical site infection and chin numbness),24-hour postoperative pain degree(VAS score),cosmetic effect,and satisfaction were compared between the two groups.Results Compared with open thyroidectomy group,the operation time was prolonged and total number of lymph nodes dissected was increased in TOETSMVA group(P<0.05).There were no significant differences between the two groups in intraoperative blood loss,postoperative drainage volume,postoperative hospital stay,24-hour postoperative VAS score,and incidence of recurrent laryngeal nerve injury,hypoparathyroidism,surgical site infection and chin numbness during hospitalization(P>0.05).The scores of patient satisfaction and cosmetic effect in the TOETSMVA group were significantly higher than those in the open operation group(P<0.05).At 6 months after operation,all the above-mentioned complications were not observed in both groups.In TOETSMVA group,2 patients had temporary recurrent laryngeal nerve injury,1 patient had temporary hypoparathyroidism,and no patients had surgical site infection and chin numbness.Conclusion TOETSMVA is not inferior to open thyroidectomy for the safety,and leads to more thorough central lymph node dissection than open thyroidectomy.Therefore,TOETSMVA is suitable for patients with early papillary thyroid carcinoma who have a higher requirement for beauty.