无充气经腋窝入路腔镜手术与传统开放手术治疗单侧甲状腺乳头状癌的对比研究

A comparative study of gasless transaxillary endoscopic surgery and traditional open surgery in treatment of unilateral papillary thyroid carcinoma

目的比较无充气经腋窝入路腔镜手术与传统开放手术治疗单侧甲状腺乳头状癌的临床疗效及术后并发症。方法回顾性分析2021年1月至2022年12月广西壮族自治区人民医院乳腺甲状腺外科行单侧甲状腺乳头状癌根治术的160例患者的临床资料,根据手术方式分为无充气经腋窝入路腔镜手术80例(腔镜组)和传统开放手术80例(开放组)。比较两组患者一般临床资料、手术相关指标、术前与术后1 d血清甲状旁腺激素及血钙水平、术后并发症发生率及患者的术后美观满意度评价。结果开放组与腔镜组术中出血量、住院时间、中央区淋巴结清扫数量、血清甲状旁腺激素及血钙水平比较差异无统计学意义(P>0.05)。腔镜组的手术时间长于开放组,术后引流量多于开放组,术后美观满意度高于开放组,差异有统计学意义(P<0.05)。两组术后并发症发生率比较差异无统计学意义(P>0.05)。结论无充气经腋窝入路腔镜甲状腺手术切口隐蔽、美观,虽然手术时间较长,但清扫淋巴结数量与开放组相当,且患者美观满意度更高,值得临床推广。

Objective To compare the clinical efficacy and postoperative complications between gasless transaxillary endoscopic surgery and traditional open surgery in treatment of unilateral papillary thyroid carcinoma.Methods The clinical data of 160 patients undergoing a radical operation to remove unilateral papillary thyroid carcinoma in the Department of Breast and Thyroid Surgery of the People′s Hospital of Guangxi Zhuang Autonomous Region from January 2021 to December 2022 were retrospectively analyzed.According to different operation procedures,the patients were divided[LM]into 80 cases receiving the gasless transaxillary approach endoscopic surgery(endoscopic group)and 80 cases receiving the traditional open surgery(open group).The general clinical data,operation-related indicators,levels of parathyroid hormone and serum calcium before and 1 day after operation,incidence of postoperative complications and postoperative aesthetic satisfaction of the patients were compared between the two groups.Results There were no significant differences in the intraoperative blood loss,length of hospital stay,number of central lymph nodes dissected and levels of serum parathyroid hormone and serum calcium between the open group and the endoscopic group(P>0.05).The endoscopic group had longer surgical time,greater volume of postoperative drainage and higher postoperative aesthetic satisfaction rate than the open group,and the differences were statistically significant(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusion The incisionfor endoscopic thyroidectomy through the gasless transaxillary approach is concealed and aesthetically pleasing.Although the surgical time of this approach is longer,the number of lymph nodes dissected by the approach is comparable to that dissected by the approach of the open group,and the aesthetic satisfaction rate of the patients receiving gasless transaxillary approach is higher,so the gasless transaxillary approach is worthy of clinical promotion.