颏下小切口辅助口腔前庭入路腔镜手术在早期PTC的疗效分析

Clinical outcomes of transoral endoscopic thyroidectomy vestibular approach assisted with submental mini-incision for early thyroid papillary carcinoma

目的探讨颏下小切口辅助经口腔前庭入路腔镜甲状腺手术(transoral endoscopic thyroidectomy vestibular approach,TOETVA)与传统TOETVA的效果差异。方法回顾性分析2019年12月至2021年5月期间于济宁医学院附属医院甲状腺外科行TOETVA的63例cT1N0M0期甲状腺乳头状癌(PTC)患者资料,其中男性4例,女性59例,年龄17~46岁。其中颏下小切口辅助27例(观察组),行传统TOETVA 36例(对照组),采用成组χ^(2)检验及成组t检验,比较2组患者的近期和远期疗效。结果观察组手术时间[(146.63±38.62)min]比对照组[(167.78±36.71)min]缩短(t=-2.21,P=0.031),术后恢复正常饮食时间[(2.11±0.89)d]较对照组[(2.72±1.16)d]早(t=-2.28,P=0.026),且观察组出现下颌麻木症状的患者比例低于对照组(0比16.67%,χ^(2)=4.97,P=0.026),差异均具有统计学意义。2组患者的术中出血量、术后引流量、中央区淋巴结检出量、气体栓塞、术后出血、术后感染、皮肤烫伤、皮下积液、声音嘶哑、饮水呛咳等差异均无统计学意义(P值均>0.05)。2组患者术后6个月复查甲状腺超声均未出现异常,患者均对手术切口表示满意。结论在早期PTC患者中,颏下小切口辅助TOETVA与传统TOETVA具有相同的手术有效性,但能降低手术时间,同时能减少术后下颌麻木症状的概率,可提高患者围手术期生活质量。

Objective To investigate the efficacy of transoral endoscopic thyroidectomy vestibular approach(TOETVA)assisted with submental mini-incision in early thyroid papillary carcinoma.Methods A total of 63 patients with early papillary thyroid carcinoma(cT1N0M0)were included who underwent TOETVA from December 2019 to May 2021 in Department of Thyroid Surgery of the Affiliated Hospital of Jining Medical University.There were 4 males and 59 females,aged from 17 to 46 years old.Of those 36 patients received traditional TOETVA as control and 27 patients accepted modified TOETVA assisted with submental mini-incision.The clinical outcomes of patients in two groups were compared.Chi-square test and t test were used in statistical analyses.Results Compared to control group,modified TOETVA group had the less mean operation time[(146.63±38.62)minutes vs.(167.78±36.71)minutes,t=-2.21,P=0.031],the shorter time required for returning to normal diet after operation[(2.11±0.89)days vs.(2.72±1.16)days,t=-2.28,P=0.026],and the lower probability of mandibular numbness(0 vs.16.67%,χ^(2)=4.97,P=0.026).There was no significant difference between two groups in intraoperative blood loss,postoperative drainage volume,number of central lymph nodes dissection,and postoperative complications such as gas embolism,postoperative bleeding,postoperative infection,skin burns,subcutaneous effusion and so on(all P>0.05).After 6 months of operation,the thyroid ultrasound of the patients in two groups showed no recurrence,and the patients were satisfied with their surgical incision appearances.Conclusion Both the modified and traditional TOETVA show similar efficacies for treatments of early thyroid papillary carcinoma,but the modified TOETVA can reduce the operation time and improve the quality of life.