无充气腋窝入路腔镜手术治疗甲状腺微小乳头状癌的临床疗效观察

Clinical efficacy of endoscopic thyroidectomy by gasless unilateral axillary approach for the treatment of papillary thyroid microcar cinoma

目的探讨无充气腋窝人路腔镜手术治疗甲状腺微小乳头状癌(papillarythyroidmicrocar cinoma,PTMC)的临床疗效及安全性。方法回顾性分析2019年1月至2022年3月南京中医药大学附属南京中医院甲状腺乳腺外科收治的110例单侧PTMC患者为临床研究对象,根据患者手术方式分为无充气胶窝人路腔镜甲状腺手术(endoscopicthyroidectomybygasless unilateral axillary approach,ETGUA)组30例和小切口腔镜辅助甲状腺手术(minimally invasivevideo-assisted thyroidectomy,MIVAT)组80例,对比2组手术相关指标、术后3个月美观满意率及术后1周和术后3个月颈前区功能状态差异。采用SPSS26.0统计软件进行数据处理,分析并得出结论,P<0.05为差异有统计学意义。结果ETGUA组淋巴结清扫数(6.60±4.41)枚少于MIVAT组淋巴结清扫数(9.63±6.25)枚(P<0.05);ETGUA组手术总时长(169.83±28.76)min、术后引流量(173.60±94.33)ml、术后拔管时间(5.73±1.86)d显著高于MIVAT组手术总时长(145.56+33.89)min、术后引流量(107.28±53.82)ml、术后拔管时间(2.88±1.07)d(P<0.01);两组术中出血量、淋巴结阳性数、术后住院时间对比差异无统计学意义(P>0.05)。ETCUA组美观满意率较MIVAT组具有显著优势(90%vs70%)(P<0.01)。对比两组术后颈前区功能状态,术后1周,ETCUA组吞咽不适或伴牵拉感发生情况优于MIVAT组(P<0.05),两组在颈部疼痛评分、感觉功能异常(颈部压迫感、异物感、麻木及针刺感)及发声困难情况方面,差异无统计学意义(P>0.05);术后3个月,ETGUA组颈部感觉功能异常(颈部压迫感、异物感、麻木及针刺感)和吞咽不适或伴牵拉感发生情况优于MIVAT组(P<0.05),两组颈部疼痛评分和发声困难比较,差异无统计学意义(P>0.05)。随访至今,两组均无局部复发及远处转移征象。结论两种微创腔镜手术治疗单侧PTMC均安全可行且有效,其中,ETGUA术式创口隐蔽且有利于保护颈前区功能,更加适用于具有强烈美容需求的适应证患者,可作为其优先推选方案.

Objective To compare and explore the clinical efficacy and safety of endoscopic thyroidecto-my by gasless unilateral axillary approach for the treatment of papillary thyroid microcar cinoma(PTMC).Methods One hundred and ten patients with unilateral PTMC admitted to the Department of Thyroid and Breast Surgery.Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine,from Jan.32019 to Mar.2022 were used as clinical study subjects,and according to the patients'choice of surgical modality,they were divided into 30 cases in the endoscopic thyroidectomy by gasless unilateral axillary approach(ETGUA)group and 80 cases in the minimally invasive video-assisted thyroidectomy(MIVAT)group.We retrospectively compared and analyzed the dfferences in the surgery-related indexes,aesthetic satisfaction rate at 3 months postoperatively and functional status of the anterior cervical region between the 2 groups.SPSS 26.0 statistical sofware was used to process the data,analyze and draw conclusions.P<0.05 was considered a statistically significant difference.Results The number of lymph nodes cleared in the study group(6.60±4.41)was less than that in the control group(9.63±6.25)(P<0.05);the total operative time(169.83±28.76)min,postoperative drainage(173.60±94.33)ml,and time to remove drainage tubes after surgery(5.73±1.86)d was significantly higher than the total operative time(145.56±33.89)min,postoperative drainage(107.28±53.82)ml,and time to remove drainage tubes after surgery(2.88±1.07)d in the control group(P<0.01);the intraoperative bleeding,number of positive lymph nodes,and postoperative hospital stay were not statistically significant between the two groups(P>0.05).The aesthetic satisfaction rate of the study group had a significant advantage over the control group(90% vs 70%)(P<0.01).Comparing the functional status of the anterior cervical region between the two groups after surgery,the occurrence of swallowing discomfort or with pulling sensation was better in the study group than in the control group I week after surgery(P<0.05),and there was no statistically significant difference between the two groups in the occurrence of neck pain score,abnormal sensory function(neck pressure,foreign body sensation,numbness and pins and needles) and vocal dificulty(P>0.05);3 months after surgery,abnormal sensory function of the neck in the study group at 3 months postoperatively,the occurrence of abnormal neck sensory function(neck pressure,foreign body sensation,numbness and pins and needles sensation)and swallowing discomfort or pulling sensation were better in the study group than those in the control group(P<0.05).There were no signs of local recurrence or distant metastasis in both groups at follow-up to date.Conclusions Both minimally endoscopic thyroidectomy procedures were safe,feasible,and effective in the treatment of unilateral PTMC.Among them,the ETCUA is more suitable for patients with strong cosmetic needs within the indications because of its concealed incision and its ability to protect the function of the anterior cervical region,and can be the preferred option.