不同手术入路甲状腺根治术治疗分化型甲状腺癌患者的安全性及预后观察

Safety and prognosis observation of patients with different operation approaches for the treatment of differentiated thyroid cancer by radical thyroidectomy

目的 观察不同手术入路甲状腺根治术治疗分化型甲状腺癌患者的安全性及预后。方法 选择2018年1月至2020年12月南通大学附属如皋医院收治的84例分化型甲状腺癌患者,采用随机数字表法将其分为对照组和观察组,每组各42例。观察组行改良Miccoli术,对照组经乳晕入路行甲状腺癌根治术。记录两组围手术期指标、视觉模拟评分法(VAS)、癌症病人生活质量测定量表核心量表(EORTC QLQ-C30)评分和术后并发症。结果 观察组手术时间、住院时间和颈部恢复活动时间短于对照组,术中出血量和术后引流量小于对照组,差异有统计学意义(P <0.05)。整体分析发现,两组VAS评分在时间、组间及交互作用比较,差异均有统计学意义(P <0.05)。进一步两两比较,组内比较:术后72 h,两组VAS评分均高于术前及术后12、24、48 h,差异有统计学意义(P <0.05)。组间比较:术后12、24 h观察组VAS评分低于对照组,差异有统计学意义(P <0.05)。术后1个月,两组QLQ-C30各项评分高于术前,且观察组躯体功能、情绪功能、社会功能和总体健康评分均高于对照组,差异有统计学意义(P <0.05)。术后,两组并发症发生率比较,差异无统计学意义(P> 0.05)。结论 改良Miccoli术治疗分化型甲状腺癌患者可降低术中出血量和术后引流量,减少患者康复时间和住院时间,改善患者预后,且安全性较高,具有推广价值。

Objective To observe the safety and prognosis of patients with differentiated thyroid cancer treated by radical thyroidectomy with different operation approaches. Methods Eighty-four patients with differentiated thyroid cancer admitted to Rugao Hospital Affiliated to Nantong University from January 2018 to December 2020 were selected, they were divided into control group and observation group by random number table method, with 42 cases in each group.The observation group was treated with modified Miccoli operation, and the control group was treated with radical thyroidectomy via areola approach. Perioperative indicators, visual analogue scale(VAS), European Organization for Research and treatment of cancer quality of life questionnaire(EORTC QLQ-C30) score, and postoperative complications were recorded. Results The operation time, hospital stay time, and neck recovery time in the observation group were shorter than those in the control group, and the intraoperative blood loss and postoperative drainage volume were smaller than those in the control group, with statistically significant differences(P < 0.05). Overall analysis showed that VAS score of two groups had statistical significance in time, between groups, and interaction(P < 0.05). Further pairwise comparison, intra-group comparison: VAS scores of both groups at 72 h after surgery were higher than those before surgery and 12, 24, and 48 h after surgery, with statistically significant differences(P < 0.05). Comparison between groups: VAS score of the observation group was lower than that of the control group at 12 and 24 h after surgery, and the differences were statistically significant(P < 0.05). One month after surgery, QLQ-C30 scores in both groups were higher than those before surgery, and physical function,emotional function, social function, and overall health scores in observation group were higher than those in control group, and the differences were statistically significant(P < 0.05). There was no significant difference in the total incidence of postoperative complications between the two groups(P > 0.05). Conclusion Modified Miccoli operation treatment for differentiated thyroid cancer patients can reduce intraoperative blood loss and postoperative drainage volume, reduce patients’ recovery time and hospital stay time, improve patients’ prognosis, and have high safety, which is worthy of promotion.