基于倾向性评分匹配的腔镜与开放甲状腺手术早期效果对比

Comparation of early outcomes between endoscopic and open thyroid sugery based on propensity score matching

目的对比腔镜与开放甲状腺手术的早期有效性、安全性及美容效果,初探腔镜甲状腺手术对患者的心理影响。方法回顾性分析2020年7月至2021年6月首都医科大学宣武医院甲状腺乳腺疾病诊疗中心收治的腔镜与开放甲状腺手术病例资料。应用倾向性评分匹配(PSM)对腔镜组和开放组进行1∶1匹配,对比两组术后早期的临床理化指标、疼痛视觉模拟评分(VAS)、术后3个月的温哥华瘢痕评分(VSS)以及术后6个月的焦虑自评分(SAS)。结果经过PSM,腔镜组和开放组分别有94例入组,两组可能影响术式选择的基线资料比较,差异均无统计学意义(P>0.05)。在甲状腺癌手术中腔镜组的前哨淋巴结数和中央区淋巴结数均少于开放组,差异均有统计学意义(P<0.05),但两组的前哨淋巴结和中央区淋巴结中阳性淋巴结数差异均无统计学意义(P>0.05);两组前哨淋巴结转移率、中央区淋巴结转移率和前哨活检准确率差异均无统计学意义(P>0.05)。腔镜组手术时间长于开放组,出血量少于开放组,甲状旁腺移植率低于开放组,术后第1天甲状旁腺激素(PTH)高于开放组,术后第1天引流量和总引流量多于开放组,术后第1天和第2天VAS均大于开放组,VSS总分和SAS总分均小于开放组,差异均有统计学意义(P<0.05)。两组的术后暂时性甲状旁腺功能减退、永久性甲状旁腺功能减退、喉返神经损伤、声音嘶哑发生率及带引流管天数、术后住院天数、出院时VAS方面差异均无统计学意义(P>0.05)。结论腔镜甲状腺手术对于肿瘤处理的有效性与开放手术相同,整体并发症、美容效果以及对患者的心理影响均优于开放性手术。

Objective To compare the efficacy,safety and cosmetic results between endoscopic and open thyroid surgery,explore the effect of endoscopic thyroid surgery on psychologic status.Methods The data of endoscopic and open thyroid surgery cases admitted to the Center for Thyroid and Breast Diseases in Xuanwu Hospital,Capital Medical University from July 2020 to June 2021 were retrospectively analyzed.Propensity score matching(PSM)was applied for 1∶1 matching between the endoscope group and open group.The early postoperative clinicopathological results,visual analogue scale(VAS)of pain,vancouver scar scales(VSS)3 months after surgery and self rating anxiety scale(SAS)were compared between the two groups.Results After PSM the endoscopic and open groups had 94 cases enrolled respectively,there was no statistical difference between the two groups in the clinical data that might influence the choice of surgical procedure.The number of sentinel lymph nodes and central lymph nodes removed in the endoscopic group was less than that in the open group,the differences were statistically significant(P<0.05),however there was no statistical difference in the number of positive lymph nodes in sentinel biopsy and central neck dissection(P>0.05);there was no significant difference in sentinel lymph node metastasis rate,central lymph node metastasis rate and sentinel biopsy accuracy between the two groups(P>0.05).The operation time of the endoscopic group was longer,the blood loss was less,the parathyroid transplantation rate was lower,the parathyroid hormone on the first postoperative day was higher,and the drainage volume(both total and the first postoperative day)were higher,the VAS of pain on the first and second postoperative day were higher,the VSS and SAS scores were lower than those in the open group respectively,the differences were statistically significant(P<0.05).There were no statistically significant differences between the two groups in the incidence of temporary and permanent hypoparathyroidism,recurrent laryngeal nerve injury,hoarseness,days with drainage tube,length of postoperative hospital stay,and VAS at discharge(P>0.05).Conclusion Endoscopic thyroid surgery has the same efficacy as open surgery in tumor management,and its overall complication,aesthetic effect and psychological impact on patients are superior to open surgery.