无充气腋窝入路与经胸乳入路腔镜甲状腺癌根治术的效果分析

Effect of radical laparoscopic thyroidectomy via axillary approach vs.transthoracic approach

目的对比无充气腋窝入路与经胸乳入路腔镜甲状腺癌根治术的临床疗效,以便为临床制定适合腔镜下甲状腺癌根治术术式提供参考。方法选取2019年1月至2022年2月医院收治的168例甲状腺癌患者,以随机数字表法分为研究组、对照组,各84例。对照组行经胸乳入路腔镜甲状腺癌根治术,研究组行无充气腋窝入路腔镜甲状腺癌根治术。统计两组手术情况、甲状旁腺功能变化情况,对比两组术后疼痛即围术期应激情况,比较两组术后并发症及患者对切口满意情况。结果研究组手术时间、术后引流量均高于对照组(P<0.05),两组淋巴结清扫数量比较差异无统计学意义(P>0.05)。两组手术前后甲状旁腺素(PTH)、血钙差值比较差异无统计学意义(P>0.05)。两组组内术前、术后1个月、术后3个月的疼痛视觉模拟评分(VAS)评分比较差异有统计学意义(P<0.05),两组间的VAS评分差异无统计学意义(P>0.05),两组的VAS评分变化趋势无差别(P>0.05)。两组组内术前、术后1 d、术后3 d的肾上腺素(Adr)、皮质醇(Cor)比较差异有统计学意义(P<0.05),两组的Adr、Cor差异无统计学意义(P>0.05),两组的Adr、Cor变化趋势无差别(P>0.05)。两组总并发症发生率比较差异无统计学意义(P>0.05)。研究组切口美容满意度高于对照组(P<0.05)。结论无充气腋窝入路与经胸乳入路在腔镜甲状腺癌根治术中效果、安全性方面相近,虽然无充气腋窝入路耗时长、术后引流量较高,但术式术后美容效果更佳。

Objective To compare the clinical effect of endoscopic radical thyroidectomy with non⁃inflat⁃able axillary approach and transthoracic mammary approach.Methods A total of 168 patients with thyroid cancer admitted to our hospital from January 2019 to February 2022 were divided into study group and control group by random number table method,with 84 cases in each group.The control group received laparoscopic radical thyroid⁃ectomy via breast and thoracobreast approach,while the study group received the thyroidectomy via inflatable axil⁃lary approach.The surgical operations and the changes of parathyroid function of the two groups were analyzed.The two groups were compared in terms of postoperative pain,perioperative stress,postoperative complications and patients′satisfaction with the incision.Results The operation time and postoperative drainage volume in the study group were longer and higher than those in the control group(P<0.05),but there was no significant difference in the number of lymph node dissection between them(P>0.05).There were no significant differences in PTH and serum calcium between them either before and after operation(P>0.05).The VAS scores showed significant differences in each group before surgery,1 month after surgery and 3 months after surgery,respectively(P<0.05),but no significant differences between the two groups at the three time points(P>0.05).There was no significant difference in the varying trend of VAS scores between the two groups(P>0.05).The levels of adrenalin(Adr)and cortisol(Cor)were significantly different within each group at the three time points(P<0.05),but there were no differences in the level of Adr and Cor between the two group at respective time point.There were no significant differences in the varying trends of Adr and Cor scores between the two groups(P>0.05).There was no significant difference in total complication rate between the groups(P>0.05).The rate of patient′s satisfaction with incisional cosmetics in the study group was significantly higher than that in the control group(P<0.05).Conclusion The effect and safety of non⁃inflatable axillary approach are similar to those of transthoracic mammary approach for laparoscopic radical thyroidectomy.Although it takes longer time and has larger postoperative drain⁃age,the non⁃inflatable axillary approach is better from the perspective of postoperative cosmetic effect.