腔镜甲状腺切除术和开放式甲状腺切除术治疗分化型甲状腺癌的对比研究

Comparative study of endoscopic thyroidectomy versus open thyroidectomy in the treatment of differentiated thyroid cancer

目的比较腔镜甲状腺切除术(ET)和开放式甲状腺切除术(OT)治疗分化型甲状腺癌(DTC)的效果。方法抽取濮阳市安阳地区医院2018年1月至2020年9月收治的98例DTC患者,按随机数字表法分为ET组(采用ET治疗)和OT组(采用OT治疗),每组49例。比较两组的临床疗效、围术期指标、术后疼痛情况、甲状腺球蛋白(Tg)水平、血管内皮生长因子(VEGF)水平及并发症发生率。结果ET组总有效率(91.84%,45/49)高于OT组(75.51%,37/49),P<0.05。ET组手术时间长于OT组,切口长度、术中出血量及住院时间均少于对照组(P均<0.05)。ET组视觉模拟评分法评分低于OT组(P<0.05),两组术后镇痛药使用率比较差异未见统计学意义(P>0.05)。术后1 d,ET组Tg及VEGF水平低于OT组(P<0.05)。ET组并发症发生率(4.08%,2/49)低于OT组(16.33%,8/49),差异有统计学意义(P=0.045)。结论与OT相比,DTC患者采用ET治疗虽会延长手术时间,但临床效果确切,可减轻手术创伤和术后疼痛度,改善甲状腺功能和VEGF表达,降低并发症发生率。

Objective To compare the effects of endoscopic thyroidectomy(ET)versus open thyroidectomy(OT)in the treatment of differentiated thyroid cancer(DTC).Methods A total of 98 patients with DTC treated in Anyang Regional Hospital of Puyang City from January 2018 to September 2020 were selected and divided into ET group(treated by ET)and OT group(treated by OT)by random number table method,with 49 cases in each group.The clinical effects,perioperative conditions,postoperative pain,thyroglobulin(Tg)level,vascular endothelial growth factor(VEGF)level,and complication rate were compared between the two groups.Results The total effective rate of the ET group(91.84%,45/49)was higher than that of the OT group(75.51%,37/49),P<0.05.The operation duration of ET group was longer than that of the control group,while incision length and hospital stay of the ET group were shorter than those of the control group,and the intraoperative blooding volume was lower than that of the control group(all P<0.05).The visual analogue scale score of the ET group was lower than that of the OT group(P<0.05);there was no significant difference in postoperative analgesic utilization rate between the two groups(P>0.05).The 1-day postoperative levels of Tg and VEGF in the ET group were lower than those in the OT group(P<0.05).The complication rate in the ET group(4.08%,2/49)was lower than that in the OT group(16.33%,8/49),P=0.045.Conclusions Compared with OT,ET treatment for DTC patients will prolong the operation time,but has definite clinical effects,which can reduce surgical trauma and postoperative pain,improve thyroid function and VEGF expression,and reduce the incidence of complications.