分化型甲状腺癌患者采用经乳晕入路腔镜甲状腺手术治疗的临床效果观察

Clinical Effect Observation of Endoscopic Thyroidectomy through Areola Approach for Patients with Differentiated Thyroid Cancer

目的 探讨分化型甲状腺癌患者采用经乳晕入路腔镜甲状腺手术治疗的临床效果观察。方法 将2021年1月-2022年1月在本院外科治疗的72例分化型甲状腺癌患者随机分为两组,对照组使用传统开放手术,观察组使用经乳晕入路腔镜甲状腺手术,对比两组的各项手术指标、并发症、疼痛程度、血清PTH及Ca^(2+)水平、美观度相关指标。结果 观察组手术时间长于对照组,而术中出血量、术后拔管时间、颈部恢复活动时间、住院时间均少于对照组(P<0.05),但两组淋巴结清扫数目相当(P>0.05);颈部不适、皮下瘀斑、切口感染、声音嘶哑、暂时性喉返神经损伤、甲状旁腺损伤等并发症相比,两组相当(P>0.05);术后12h、24h、48h的VAS疼痛评分相比,观察组均低于对照组(P<0.05);术后1d、1个月的PTH、Ca^(2+)相比,观察组术后1d的PTH高于对照组(P<0.05),其他两组均相当(P>0.05);术后1个月的VSS评分、PSAS评分、VSI评分、RSI评分相比,观察组前三项更低(P<0.05),但两组第四项相当(P>0.05)。结论 分化型甲状腺癌患者采用经乳晕入路腔镜甲状腺手术治疗的临床效果显著,虽明显延长了手术时间,但创伤更小,术后恢复更快,疼痛更轻,对甲状旁腺功能影响小,能保障手术疗效,减少并发症,提高切口美观度。

Objective To investigate clinical effect of endoscopic thyroidectomy through areola approach for patients with differentiated thyroid cancer.Methods The paper chose 72 patients with differentiated thyroid cancer with surgical treatment in our hospital from January 2021 to January 2022,and divided them into two groups randomly.Control group was treated with traditional open surgery,while observation group with endoscopic thyroidectomy through areola.Surgical indicators,complications,pain level,serum PTH and Ca2+levels,and aesthetic indicators between two groups were compared.Results Observation group had longer surgical time than control group,while intraoperative bleeding volume,postoperative extubation time,neck recovery time and length of stay was also less than control group(P<0.05),but number of lymph node dissection between two groups was equivalent(P>0.05);complications of neck discomfort,subcutaneous ecchymosis,incision infection,hoarseness,temporary recurrent laryngeal nerve injury,and parathyroid gland injury was comparable between two groups(P>0.05);VAS pain scores at 12,24,and 48 hours after surgery in observation group were lower than control group(P<0.05);the PTH and Ca2+levels in observation group were higher than control group on the first day and one month after surgery,(P<0.05),while other indicators between two groups were comparable(P>0.05);VSS scores,PSAS scores,VSI scores,and RSI scores of observation group were lower than control group one month after surgery(P<0.05),but the fourth item between two groups was equivalent(P>0.05).Conclusion Endoscopic thyroidectomy through areola approach can achieve significant clinical effect for differentiated thyroid cancer patients.Although it prolongs surgical time significantly,it can have smaller trauma,faster postoperative recovery,lighter pain,and small impact on parathyroid function,which can ensure the surgical effect,reduce complications,and improve aesthetic appearance of the incision.