经腋窝入路与经胸乳入路腔镜单侧甲状腺叶切除治疗甲状腺良性肿瘤的疗效

Efficacies of endoscopic unilateral thyroidectomy via transaxillary approach and transthoracic breast approach in the treatment of benign thyroid tumors

目的探讨经腋窝入路与经胸乳入路腔镜单侧甲状腺叶切除治疗甲状腺良性肿瘤的近期疗效。方法选取83例甲状腺良性肿瘤患者,根据不同入路方式分为经腋窝入路组(43例)和经胸乳入路组(40例)。比较2组患者手术时间、术中出血量、住院时长、术后引流量、暂时性喉返神经损伤和术后24 h视觉模拟量表(VAS)评分等手术相关指标;比较2组患者术前、术后24 h白细胞计数(WBC)和C反应蛋白(CRP)水平;比较2组患者术后3个月美容满意度、瘢痕自我关注度;比较2组患者术前和术后3个月生活质量评分和并发症发生率。结果经腋窝入路组手术时间短于经胸乳入路组(P<0.05),术中出血量和术后引流量少于经胸乳入路组(P<0.05),2组住院时长、术后24 h VAS评分和暂时性喉返神经损伤比较差异无统计学意义(P>0.05)。2组患者术后24 h的WBC和CRP水平较术前均上升(P<0.05),但组间比较差异无统计学意义(P>0.05)。经腋窝入路组的美容满意度高于经胸乳入路组(P<0.05);2组瘢痕自我关注度比较差异无统计学意义(P>0.05)。2组患者术后3个月心理、健康、环境、家庭和亲密度评分较术前明显升高(P<0.05),但组间比较差异无统计学意义(P>0.05)。2组患者并发症发生率比较差异无统计学意义(P>0.05)。结论经腋窝入路和经胸乳入路腔镜单侧甲状腺叶切除均能有效治疗甲状腺良性肿瘤,可取得良好的美容满意度,提高患者生活质量,其中经腋窝入路手术时间较短,美容效果较好,对于美容需求较高的患者可选择经腋窝入路。

Objective To investigate the short-term efficacies of endoscopic unilateral thyroidectomy via transaxillary approach and transthoracic breast approach in the treatment of benign thyroid tumors.Methods A total of 83 patients with benign thyroid tumors were selected and divided into the transaxillary approach group(43 cases)and the transthoracic breast approach group(40 cases)according to different approaches.The surgery-related indicators including operation time,intraoperative blood loss,hospital stay,postoperative drainage volume,temporary recurrent laryngeal nerve injury and visual analogue scale(VAS)score 24 hours after operation of the two groups were compared.The levels of white blood cell count(WBC)and C-reactive protein(CRP)before operation and 24 hours after operation of the two groups were compared.The cosmetic satisfaction and scar self-attention 3 months after operation of the two groups were compared.The quality of life score and incidence of complication before operation and 3 months after operation of the two groups were compared.Results The operation time in the transaxillary approach group was shorter than that in the transthoracic breast approach group(P<0.05),and the intraoperative blood loss and postoperative drainage volume were less than those in the transthoracic breast approach group(P<0.05).There was no statistically significant difference in the hospital stay,VAS score 24 hours after operation or temporary recurrent laryngeal nerve injury between the two groups(P>0.05).The levels of WBC and CRP 24 hours after operation in the two groups were increased compared with those before operation(P<0.05),but there was no statistically significant difference between the two groups(P>0.05).The cosmetic satisfaction in the transaxillary approach group was higher than that in the transthoracic breast approach group(P<0.05).There was no statistically significant difference in scar self-attention between the two groups(P>0.05).The scores of psychology,health,environment,family and affinity density 3 months after operation of the two groups were significantly higher than those before operation(P<0.05),but there was no statistically significant difference between the two groups(P>0.05).There was no significantly significant difference in the incidence of complication between the two groups(P>0.05).Conclusion Endoscopic unilateral thyroidectomy via transaxillary approach and transthoracic breast approach can effectively treat benign thyroid tumors,which can achieve good cosmetic satisfaction and improve patients'quality of life.Among them,transaxillary approach has shorter operation time and better cosmetic effect,which is a good choice for patients with high cosmetic needs.