经口腔前庭腔镜甲状腺切除术联合^(131)Ⅰ治疗化型甲状腺癌的近期效果及分析

Efficacy of transoral laparoscopic thyroidectomy by vestibular approach combined with ^(131)Ⅰtreatment in differentiated thyroid carcinoma and analysis of short-and medium-term prognoses

目的:分析经口腔前庭腔镜甲状腺切除术(TOETVA)联合放射性碘131(^(131)Ⅰ)治疗分化型甲状腺癌(DTC)的效果。方法:回顾性分析2018年7月至2020年5月南方医科大学珠江医院和中山市东凤人民医院收治的80例DTC患者临床资料,按照治疗方案不同分为对照组(46例,实施TOETVA术联合优甲乐治疗)和研究组(34例,接受TOETVA术联合^(131)Ⅰ治疗)。对比两组疗效、甲状腺指标、血清白细胞分化抗原44变异型6(CD44V6)、可溶性白细胞介素-2受体(sIL-2R)水平与细胞凋亡信号受体(Fas)、细胞周期素E蛋白表达、唾液腺功能、近期进展情况。结果:研究组治疗总有效率(82.35%)比对照组(58.70%)高(P<0.05);研究组治疗后甲状腺球蛋白抗体、促甲状腺激素、甲状腺球蛋白水平均比对照组低(P<0.05);研究组治疗后血清CD44V6、sIL-2R水平与细胞周期素E蛋白均比对照组低,血清Fas蛋白表达比对照组高(P<0.05);研究组治疗前后右侧颌下腺、左侧颌下腺、右侧腮腺、左侧腮腺的排泌分数与对照组相比,差异无统计学意义(P>0.05);研究组随访2年内无病生存率(91.18%)比对照组(71.74%)高(P<0.05);研究组随访2年内复发率(2.94%)、转移率(8.82%)与对照组(13.04%、21.74%)相比,差异无统计学意义(P>0.05)。结论:TOETVA术联合^(131)Ⅰ治疗有助于提高DTC临床效果,改善患者甲状腺指标,抑制恶性细胞增殖转移,提升近期局部控制率,且对患者唾液腺功能无明显影响。

Objective To explore the clinical outcome of differentiated thyroid carcinoma(DTC)treated by transoral vestibular laparoscopic thyroidectomy(TOETVA)combined with radioactive iodine 131(^(131)Ⅰ)treatment,and analyze the short-and medium-term prognoses.Methods The clinical data of 80 DTC patients who were admitted to Zhujiang Hospital,Southern Medical University and Zhongshan Dongfeng People's Hospital from July 2018 to May 2020 were analyzed retrospectively.According to the treatment protocol,they were divided into control group(n=46,received TOETVA combined with Youjiale treatment)and research group(n=34,received TOETVA combined with ^(131)I treatment).The therapeutic effects,thyroid function,serum cluster of differentiation 44 variant 6(CD44V6),soluble interleukin-2 receptor(sIL-2R),cell apoptosis signal receptor(Fas),Cycline protein,salivary gland function,and the short-and medium-term prognoses were compared between two groups.Results The total response rate in research group was 82.35%,higher than 58.70%in control group(P<0.05).The levels of thyroglobulin antibody(TgAb),thyroid-stimulating hormone(TSH),and thyroglobulin(Tg)were all lower in research group than control group(P<0.05).After treatment,compared with control group,research group showed lower levels of serum CD44V6,sIL-2R and Cycline protein,and higher expression level of serum Fas protein(P<0.05).The SR of the right submandibular gland,left submandibular gland,right parotid gland and left parotid gland before and after treatment did not differ significantly between research group and control group(P>0.05).The disease-free survival rate in research group within 2 years of follow-up was higher than that in control group(91.18%vs 71.74%;P<0.05).No significant differences were found in the recurrence rate and metastasis rate within 2 years of follow-up between research group and control group(2.94%vs 13.04%,8.82%vs 21.74%;P>0.05).Conclusion TOETVA combined with ^(131)Ⅰtreatment can help to improve the clinical outcome of DTC,improve the thyroid function,inhibit the proliferation and metastasis of malignant cells,and raise the short-and medium-term disease-free survival rates,without affecting the salivary gland function.