基于倾向评分匹配的腔镜甲状腺手术与传统开放手术临床对比研究

A Clinical Comparison Study of Endoscopic Thyroidectomy and Tradi⁃tional Open Surgery Based on Propensity Score Matching

目的采用基于倾向评分匹配法比较腔镜甲状腺手术与传统开放手术的临床效果。方法回顾性分析南通市通州区人民医院及南通市肿瘤医院甲乳外科2019年1月—2023年1月期间施行甲状腺手术的患者共204例。根据不同手术方式将204例患者分成ET组(124例,腔镜甲状腺手术)和OTS组(80例,传统的开放甲状腺手术)。比较倾向匹配后两组患者的术中情况、并发症状况以及术后情况。结果两组患者间的BMI、TSH、病灶直径以及良恶性等资料比较,差异有统计学意义(P<0.05);将两组样本经PSM处理后,每组剩余52例研究对象匹配成功,两组间的各项资料比较,差异无统计学意义(P>0.05)。ET组的手术时间(110.63±15.11)min长于OTS组(88.97±5.69)min,但术中失血量(15.27±1.22)mL及切口长度(2.29±1.02)cm均优于OTS组,差异有统计学意义(t=9.674、6.424、9.850,P<0.05)。两组患者的24 h引流量、带管时间、术后1~3 d的VAS评分以及住院时间比较,差异有统计学意义(P<0.05)。两组患者的术后并发症总发生率比较差异无统计学意义(P>0.05)。结论倾向评分匹配后腔镜甲状腺手术的术中失血量、切口长度以及术后疼痛情况均优于传统开放手术,且两种手术的术后并发症情况并无明显差异,因此推荐小切口、出血量少、术后疼痛更轻的腔镜甲状腺手术。

Objective To compare the clinical outcomes of endoscopic thyroidectomy with traditional open surgery us⁃ing propensity score-based matching method.Methods A retrospective analysis of a total of 204 patients who under⁃went thyroid surgery in the Department of Thyroid and Breast Surgery of Nantong Tongzhou District People's Hospital and Nantong Cancer Hospital from January 2019 to January 2023.According to different surgical methods,204 pa⁃tients were divided into ET group(124 cases,endoscopic thyroid surgery)and OTS group(80 cases,traditional open thyroid surgery).The intraoperative conditions,complications and postoperative conditions of the two groups of pa⁃tients after propensity matching were compared.Results There were statistically significant differences in BMI,TSH,lesion diameter,benign and malignant data between the two groups(P<0.05);after the two groups of samples were pro⁃cessed by PSM,the remaining 52 subjects in each group were successfully matched.There was no statistically signifi⁃cant difference in the data between the two groups(P>0.05).The operation time of ET group(110.63±15.11)min was longer than that of OTS group(88.97±5.69)min,but the intraoperative blood loss(15.27±1.22)mL and incision length(2.29±1.02)cm were better than those of OTS group,and the differences were statistically significant(t=9.674,6.424,9.850,P<0.05).There were statistically significant differences in 24 h drainage volume,catheter time,VAS score at 1-3 d after operation and hospitalization time between the two groups(P<0.05).There was no statistically significant dif⁃ference in the total incidence of postoperative complications between the two groups(P>0.05).Conclusion The intra⁃operative blood loss,incision length,and postoperative pain of endoscopic thyroidectomy after propensity score match⁃ing were better than that of traditional open surgery,and there was no significant difference in postoperative complica⁃tions between the two surgeries.Therefore,we recommend the endoscopic thyroidectomy with a small incision,less bleeding,and less postoperative pain.