cN0甲状腺乳头状癌免充气经口腔镜入路手术的效果

Therapeutic effects of gasless transoral endoscopic thyroidectomy vestibular approach for cN0 papillary thyroid carcinoma

目的:探讨免充气经口腔镜入路手术治疗淋巴结术前评估为阴性(cN0)的甲状腺乳头状癌(PTC)的效果。方法:选取2019年1月至2021年12月郑州大学第一附属医院甲状腺外科收治的资料完整的cN0 PTC83例,其中30例采用常规经口腔前庭腔镜甲状腺切除术(充气组),53例采用免充气经口腔前庭甲状腺切除术(免充气组)。比较两组术中指标、术后治疗效果指标、并发症发生情况以及术后24 h疼痛评分、美容满意度、瘢痕自我关注度评分(均按1、2、3级评分)。结果:所有患者均顺利完成手术,未出现中转开放及二次手术。免充气组手术时间(138.06±37.11) min,术中出血量(5.38±1.33) mL,与充气组(178.23±50.37) min和(7.33±4.10) mL比较,显著减少(P<0.05);免充气组手术开始1 h动脉血二氧化碳分压为(37.25±6.16) mmHg(1 mmHg=0.133 kPa),低于充气组的(43.22±6.47) mmHg(P<0.05)。两组均未发生明显CO_(2)气体栓塞。两组中央区淋巴结清扫数、阳性淋巴结数、术后引流量、术后住院时间差异均无统计学意义(P>0.05)。两组术后均未出现感染。两组声音嘶哑、饮水呛咳、下颏麻木、术后患者美容满意度、瘢痕自我关注度、术后24 h疼痛评分差异均无统计学意义(P>0.05)。结论:免充气经口腔前庭入路治疗cN0 PTC具有一定有优势。

Aim:To investigate the therapeutic effects of gasless transoral endoscopic thyroidectomy vestibular approach for cN0 thyroid papillary carcinoma(PTC).Methods:A total of 83 cN0 PTC patients with complete data from January 2019 to December 2021 in the Department of Thyroid Surgery,the First Affiliated Hospital of Zhengzhou University were selected.Among them,30 patients underwent normal transoral vestibular endoscopic thyroidectomy(gas group),and 53 patients underwent gasless transoral vestibular endoscopic thyroidectomy(gasless group).The intraoperative indicators,postoperative treatment effect indicators,complications,pain score at 24 hours after operation,cosmetic satisfaction score and scar self-attention score were compared between the two groups(all scored according to the 1,2 and 3 levels).Results:All operation were successfully completed with no conversion to open operation or second operation.The operation time(138.06±37.11)min of the gasless group was significantly lower than the gas group(178.23±50.37)min(P<0.05),and intraoperative blood loss(5.38±1.33)mL of the gasless group was also significantly lower than the gas group(7.33±4.10)mL(P<0.05).The partial pressure of CO_(2) in the gasless group was(37.25±6.16)mmHg(1 mmHg=0.133 kPa)at 1 hour after operation,which was lower than that in the gas group(43.22±6.47)mmHg(P<0.05).No CO_(2) gas embolism occurred in the two groups.There were no significant differences in the number of central lymph nodes dissected,the number of positive lymph nodes,postoperative drainage volume,or postoperative hospital stay between the two groups(P>0.05).There was no infection in the two groups after operation.There were no significant differences in hoarseness,choking in drinking water,chin numbness,postoperative cosmetic satisfaction,scar self-attention,or pain score at 24 hours after operation between the two groups(P>0.05).Conclusion:The treatment of cN0 PTC by gasless transoral endoscopic thyroidectomy vestibular approach has advantages.