胸乳入路腔镜手术治疗甲状腺乳头状癌的临床研究

Clinical study of endoscopic surgery through thoraco mammary approach in treatment of thyroid papillary carcinoma

目的探讨胸乳入路腔镜甲状腺切除术在甲状腺乳头状癌患者中的疗效及对Wnt和整合素信号通路的影响。方法选取2018年7月至2020年3月三二〇一医院确诊为甲状腺乳头状癌并住院行手术治疗的患者136例,按术式不同分为观察组(68例)和对照组(68例)。对照组予开放甲状腺切除术治疗。观察组予胸乳入路腔镜甲状腺切除术治疗。比较免疫功能(CD4^(+)、CD8^(+)和CD4^(+)/CD8^(+))、疼痛指标(PGE2、IL-6、Cor和VAS评分),采用RT-PCR法检测手术前后两组(WNT1、β-catenin、GSK3β)及整合素信号通路。结果术后3 d,较对照组,观察组CD4^(+)和CD4^(+)/CD8^(+)水平明显更高[(27.62±2.52)vs(24.63±2.67),(0.66±0.18)vs(0.52±0.13)],而CD8^(+)水平明显更低[(41.62±3.54)vs(45.62±3.63)](P<0.001);观察组PGE2、IL-6、Cor、VAS均显著低于对照组[(48.54±9.86)vs(57.21±8.12),(5.13±0.71)vs(6.99±0.95),(511.23±67.52)vs(633.12±71.47),(1.26±0.56)vs(3.99±2.06)](P<0.001);观察组WNT1、β-catenin、GSK3β、整合素β1、FAK、Ras、MAPK mRNA表达量均显著低于对照组[(1.79±0.15)vs(2.85±0.25),(1.94±0.15)vs(2.64±0.24),(2.13±0.19)vs(2.97±0.28),(1.95±0.17)vs(2.58±0.23),(2.15±0.16)vs(2.87±0.22),(1.95±0.18)vs(2.91±0.27),(1.89±0.12)vs(2.87±0.31)](P<0.001)。结论胸乳入路腔镜甲状腺切除术可有效减轻甲状腺乳头状癌患者术后疼痛水平,且对免疫功能影响更小,使Wnt和整合素信号通路表达受阻以降低肿瘤转移风险。

Objective To investigate the effect of endoscopic thyroidectomy through breast milk approach in patients with papillary thyroid carcinoma and its influence on Wnt and integrin signaling pathways.Methods A total of 136 patients diagnosed with papillary thyroid carcinoma in our hospital from Jul.2018 to Mar.2020 were selected and were hospitalized for surgical treatment.According to different surgical procedures,they were divided into a study group(68 cases)and a control group(68 cases).The control group was treated with open thyroidectomy and the study group was treated with thoracoscopic thyroidectomy.The two groups were compared in terms of immune function[CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)],and pain index[PGE2,IL-6,Cor and VAS score].RT-PCR method was used to detect WNT1,β-catenin,GSK3βand integrin Signal pathway before and after surgery.Results Three days after operation,compared with the control group,the study group had significantly higher CD4^(+)and CD4^(+)/CD8^(+)levels[(27.62±2.52)vs(24.63±2.67),(0.66±0.18)vs(0.52±0.13)],while the CD8^(+)level was significantly lower[(41.62±3.54)vs(45.62±3.63)](P<0.001);PGE2,IL-6,Cor,VAS of the study group were significantly lower than the control group[(48.54±9.86)vs(57.21±8.12),(5.13±0.71)vs(6.99±0.95),(511.23±67.52)vs(633.12±71.47),(1.26±0.56)vs(3.99±2.06)](P<0.001);WNT1,β-catenin,GSK3β,integrinβ1,FAK,Ras,and MAPK mRNA expression levels in the study group were significantly lower than those of the control group[(1.79±0.15)vs(2.85±0.25),(1.94±0.15)vs(2.64±0.24),(2.13±0.19)vs(2.97±0.28),(1.95±0.17)vs(2.58±0.23),(2.15±0.16)vs(2.87±0.22),(1.95±0.18)vs(2.91±0.27),(1.89±0.12)vs(2.87±0.31)](P<0.001).Conclusion Endoscopic thyroidectomy through thoracolumbar approach can effectively reduce postoperative pain in patients with papillary thyroid cancer,have a smaller impact on immune function,and block the expression of Wnt and integrin signaling pathways to reduce tumor metastasis risk.