三种入路腔镜下单侧甲状腺癌根治术的临床疗效比较

Clinical comparison of three kinds of endoscopic thyroidectomy for unilateral thyroid cancer

目的比较经腋下入路、经胸乳入路、经口腔前庭入路腔镜下单侧甲状腺癌根治术的临床效果。方法回顾性分析94例腔镜下行单侧甲状腺癌根治术的早期甲状腺癌患者的临床资料,其中经腋下入路、经胸乳入路、经口腔前庭入路的患者分别为31例、30例、33例,分别记为A组、B组和C组。比较三组的围术期指标(出血量、手术时间、术后引流量、淋巴结清扫数),并发症情况(皮下积液、甲状旁腺损伤、声嘶)及术后1、2、3年复发率和生存率。结果A组和C组手术时间均短于B组,C组手术时间短于A组(P<0.05);三组出血量、术后引流量、淋巴结清扫数比较差异均无统计学意义(P>0.05);A组、C组皮下积液发生率均低于B组(P<0.05),三组甲状旁腺损伤、声嘶发生率差异均无统计学意义(P>0.05);三组术后1、2、3年复发率和生存率比较差异均无统计学意义(P>0.05)。结论三种入路腔镜下单侧甲状腺癌根治术均有较好的临床效果,具有创伤小、疼痛轻、恢复快、美容效果好的优点,而经腋下入路、经口腔前庭入路手术时间更短、皮下积液率更低。

Objective To compare the clinical effect of endoscopic unilateral thyroidectomy through axillary approach,breast approach and oral vestibular approach.Methods The clinical data of 94 patients with early thyroid cancer who underwent endoscopic unilateral thyroidectomy were retrospectively analyzed.There were 31 cases,30 cases and 33 cases underwent endoscopic unilateral thyroidectomy through transaxillary approach,chest-breast approach and oral vestibular approach,which were recorded as group A,group B and group C respectively.The perioperative indexes(blood loss,operation time,postoperative drainage volume and lymph node clearance),complications(subcutaneous effusion,parathyroid injury and hoarseness),recurrence rates and 1-year,2-year and 3-year survival rates were taken as observation indexes.Results Operative time of group A and group C was shorter than that of group B,while that of group C was the shortest(P<0.05).The incidence of subcutaneous hydrops of group A and group C was lower than that of group B(P<0.01).There was no significant difference in the recurrence rates and the survival rates among the three groups(P>0.05).Conclusion All of the three kinds of endoscopic radical surgery for unilateral thyroid cancer have good clinical effects,with the advantages of less trauma,less pain,fast recovery and good cosmetic effect.However,the subaxillary approach and the oral vestibule approach have shorter operation time and lower subcutaneous hydrops rates.