经乳晕入路腔镜甲状腺手术治疗分化型甲状腺癌的疗效及术后复发因素分析

Endoscopic thyroidectomy via areola approach in the treatment of differentiated thyroid cancer and analysis of postoperative recurrence factors

目的探讨分化型甲状腺癌患者采用经乳晕入路腔镜甲状腺手术治疗的临床效果,并分析患者在术后的复发因素。方法回顾性选取2019年12月至2020年12月海南省琼海市人民医院行手术治疗的48例分化型甲状腺癌行手术患者,将其按照手术方式不同分为常规组(传统开放手术,n=24)和实验组(经乳晕入路腔镜手术,n=24)。对比两组患者接受不同手术方式治疗后各项围术期指标情况以及预后状况,并对引起术后患者再次复发的相关因素因素进行分析。结果实验组手术时间为(108.29±20.13)min,长于常规组[(91.18±17.05)min],但术中出血量、术后总引流量为(48.20±15.39)m L、(28.19±4.91)m L,少于常规组[(62.42±14.63)m L、(34.10±7.04)m L],疼痛评分为(3.28±0.47)分,低于常规组[(4.81±0.31)分],住院时间为(8.10±1.82)d,短于常规组[(12.93±1.47)d],差异均有统计学意义(P<0.05),但两组淋巴清扫数目方面,差异无统计学意义(P>0.05)。实验组术后并发症发生率为4.17%,明显低于常规组(25.00%),差异有统计学意义(P<0.05)。实验组切口瘢痕形成率为12.5%,显著低于常规组(58.33%),差异有统计学意义(P<0.05)。实验组术后满意度为87.50%,显著高于常规组62.50%,差异有统计学意义(P<0.05)。通过单因素分析,复发组患者传统开放手术、肿瘤最大直径≥2 cm、进行淋巴清扫的患者比率显著高于未复发组,差异均有统计学意义(P<0.05);而两组在年龄和性别方面差异无统计学意义(P>0.05)。通过多因素分析,结果发现分化型甲状腺癌患者术后复发的独立危险因素有肿瘤最大径≥2 cm、采取传统开放性手术以及没有进行淋巴清扫(OR=2.339,95%CI为1.230~4.468;OR=2.783,95%CI为1.112~6.753;OR=6.193,95%CI为3.501~11.873)。结论经乳晕入路腔镜甲状腺手术在分化型甲状腺癌患者的治疗中具有十分显著的优越性,对患者的损伤小,手术安全性高,术后出现并发症的风险低,有助于获得较好的预后。引起分化型甲状腺癌术后患者复发的危险因素主要有3个,分别是肿瘤最大径≥2 cm、传统开放性手术以及没有进行淋巴清扫。

Objective To investigate the clinical effect of endoscopic thyroidectomy via areola approach in patients with differentiated thyroid cancer,and to analyze the factors of postoperative recurrence.Methods A total of 48 patients with differentiated thyroid cancer who underwent surgery in Qionghai City People’s Hospital of Hainan Province were retrospectively selected from December 2019 to December 2020 and divided into conventional groups( traditional open surgery,n = 24) and the experimental group( laparoscopic surgery through the areola approach,n =24).The perioperative indexes and prognosis of the two groups after different surgical methods were compared,and the related factors causing recurrence were analyzed.Results The operation time of the experimental group was( 108.29 ± 20.13) min,which was longer than that of the conventional group [( 91.18 ± 17.05) min],but the intraoperative blood loss and postoperative total drainage volume were( 48.20 ± 15.39)m L,( 28.19 ± 4.91) m L,which were less than those in the routine group [( 62.42 ± 14.63) m L,( 34.10 ± 7.04) m L],the pain score was( 3.28 ± 0.47) points,which was lower than that in the routine group [( 4.81 ± 0.31) points],and the length of hospital stay was( 8.10 ±1.82) d,which was shorter than that in the conventional group [( 12.93 ± 1.47) d],the differences were statistically significant( P < 0.05).However,there was no significant difference in the number of lymphatic dissections between the two groups( P > 0.05).The incidence of postoperative complications in the experimental group was 4.17%,which was significantly lower than that in the routine group( 25.00%),and the difference was statistically significant( P < 0.05).The incision scar formation rate in the experimental group was 12.5%,which was significantly lower than that in the routine group( 58.33%),and the difference was statistically significant( P < 0.05).The postoperative satisfaction of the experimental group was 87.50%,which was significantly higher than that of the routine group( 62.50%),and the difference was statistically significant( P < 0.05).Through univariate analysis,it was found that there were significant differences in the proportion of recurrent group and non recurrent group in terms of maximum tumor diameter,whether lymph node dissection and operation mode( P < 0.05),but there were no significant differences in age and gender( P > 0.05).Through multivariate analysis,it was found that there were three independent risk factors for postoperative recurrence in patients with differentiated thyroid cancer,including not only the maximum tumor diameter ≥2 cm,but also the traditional open surgery and no lymph node dissection( OR = 2.339,95% CI = 1.230 ~ 4.468;OR = 2.783,95% CI = 1.112 ~ 6.753;OR = 6.193,95% CI = 3.501 ~ 11.873).Conclusion Endoscopic thyroidectomy via areola approach has very significant advantages in the treatment of patients with differentiated thyroid cancer.The damage caused to patients during the operation is small,the operation safety is high,and the risk of postoperative complications is low,which is helpful for patients to obtain a better prognosis.There are three main risk factors for postoperative recurrence of differentiated thyroid cancer,namely,the maximum tumor diameter ≥2 cm,traditional open surgery and no lymph node dissection.