经口前庭入路在腔镜微创甲状腺癌手术中的应用价值

Application value of transoral vestibular approach in endoscopic minimally invasive thyroid cancer surgery

目的探究经口前庭入路在腔镜微创甲状腺癌手术治疗中的应用价值。方法选取2020年3月—2022年1月湖北省黄冈市中心医院乳腺甲状腺外科诊治甲状腺乳头状癌(PTC)患者124例,采用随机数字表法分为对照组和研究组,各62例。对照组采用胸乳入路腔镜甲状腺切除术(ETE)治疗,研究组采用经口前庭入路腔镜甲状腺切除术(TOETVA)治疗。比较2组手术情况、术后引流量、住院时间、疼痛程度(VAS评分)、美容满意度(NSS评分)、炎性—免疫指标[白介素-6(IL-6)、CD4^(+)、CD8^(+)]、Wnt/β-catenin信号通路(Wnt1、β-catenin)表达水平,以及并发症发生率。结果研究组手术时间明显长于对照组,而术中出血量、术后引流量、住院时间明显少于/短于对照组(t/P=16.932/<0.001、3.704/<0.001、7.010/<0.001、5.916/<0.001);术后1、2、3 d,研究组VAS评分均显著低于对照组(t/P=5.765/<0.001、4.490/<0.001、4.865/<0.001);术后7 d,研究组NSS评分显著高于对照组(t/P=9.401/<0.001);术后3 d,研究组血清IL-6、CD8^(+)水平均明显低于对照组,而CD4^(+)水平均明显高于对照组(t/P=4.220/<0.001、3.098/<0.001、3.667/<0.001);术后3 d,研究组Wnt1、β-catenin mRNA表达水平均显著低于对照组(t/P=5.231/<0.001、6.177/<0.001);研究组术后3个月内并发症发生率明显低于对照组(χ^(2)/P=5.153/0.023)。结论TOETVA能更有效减轻PTC患者手术创伤,降低手术对机体免疫功能的影响,抑制炎性因子及Wnt/β-catenin信号通路表达。

Objective To explore the application value of transoral vestibular approach in endoscopic minimally invasive surgical treatment of thyroid cancer.Methods A total of 124 patients with papillary thyroid carcinoma(PTC)who were diagnosed and treated in the Department of Breast and Thyroid Surgery of Huanggang Central Hospital,Hubei Province from March 2020 to January 2022 were selected and divided into a control group and a study group based on the random number table method,with 62 cases in each group.The control group received thoracoscopic thyroidectomy(ETE),while the study group received transoral vestibular thyroidectomy(TOETVA).The operation conditions,postoperative drainage volume,hospital stay,pain degree(VAS score),cosmetic satisfaction(NSS score),inflammatory-immune indexes[interleukin 6(IL-6),CD4^(+),CD8^(+)],Wnt/βwere compared between the two groups The expression level of catenin signaling pathway(Wnt1,β-catenin),and the incidence of complications.Results The operation time of the study group was significantly higher than that of the control group,while the intraoperative blood loss,postoperative drainage volume and hospital stay were significantly lower than those of the control group(t/P=16.932/<0.001,3.704/<0.001,7.010/<0.001,5.916/<0.001);1,2,and 3 days after operation,the VAS scores of the study group were significantly lower than those of the control group(t/P=5.765/<0.001,4.490/<0.001,4.865/<0.001);7 days after operation,the study group The NSS score of the group was significantly higher than that of the control group(t/P=9.401/<0.001);3 days after operation,the serum IL-6 and CD8^(+) levels of the study group were significantly lower than those of the control group,while the level of CD_(4)^(+) was significantly higher than that of the control group(t/P=4.220/<0.001,3.098/<0.001,3.667/<0.001);3 days after operation,the expression levels of Wnt1 andβ-catenin mRNA in the study group were significantly lower than those in the control group(t/P=5.231/<0.001,6.177/<0.001);the incidence of complications in the study group within 3 months after surgery was significantly lower than that in the control group(χ^(2)/P=5.153/0.023).Conclusion TOETVA can more effectively reduce the surgical trauma of PTC patients,reduce the impact of surgery on the immune function of the body,and inhibit the expression of inflammatory factors and Wnt/β-catenin signaling pathway.