经腋无充气腔镜辅助与颈部开放手术治疗PTC的疗效评价:单中心342例报告

Efficacy evaluation of transaxillary non-inflatable endoscopic surgery and open neck surgery in the treatment of PTC:a single center report of 342 cases

目的:探讨经腋无充气腔镜辅助与颈部传统开放甲状腺手术治疗甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的临床应用效果比较。方法:回顾性分析2020年12月至2022年12月山东大学齐鲁医院耳鼻咽喉科收治的采用单侧经腋无充气腔镜辅助甲状腺手术(腔镜组)与单侧传统开放甲状腺手术(开放组)共342例PTC患者的资料,其中男73例,女269例;年龄16~72岁。腔镜组108例,开放组234例。结果:腔镜组在年龄(37.1±9.4)岁、BMI指数(23.4±3.4)kg/m^(2)小于开放组年龄(43.5±11.2)岁、BMI指数(25.7±3.8)kg/m^(2),差异有统计学意义(t分别为5.53、5.67,均P<0.01),2组患者住院天数比较,差异无统计学意义(P>0.05);手术时长对数曲线呈现平滑下降趋势,腔镜组总体手术时长相对一致;腔镜组患者的术中出血量(13.3±3.2)mL与开放组(14.7±6.3)mL比较,差异无统计学意义(P>0.05),但是手术时长(130.1±37.9)min多于开放组(57.4±13.7)min,差异有统计学意义(t=19.40,P<0.01);2组在术后3 d内出现暂时性喉返神经损伤等并发症方面比较,差异无统计学意义(P>0.05);腔镜组患者对手术切口美观满意度评分及切口隐藏效果评分均高于开放组,差异有统计学意义(P<0.05)。结论:经腋无充气腔镜辅助甲状腺手术相较于传统开放甲状腺手术在术后切口隐蔽性与美观度上更具优势,虽然前者手术时间更长,引流量更多,但其仍是安全可行且术后临床效果较好的手术方式。

Objective:To compare the clinical effect of transaxillary non-inflatable endoscopic surgery and traditional open thyroid surgery in the treatment of PTC.Methods:A retrospective analysis was performed on 342 patients with PTC treated in the Otorhinolaryngology Department of Qilu Hospital of Shandong University from December 2020 to December 2022.There were 73 males and 269 females,aged 16-72 years,who underwent unilateral non-inflatable transaxillary endoscopic thyroid surgery(endoscopic group) and unilateral traditional open thyroid surgery(open group).There were 108 patients in the endoscopic group and 234 in the open group.Results:The endoscopic group was lower in age(37.1±9.4 vs 43.5±11.2) years and BMI(23.4±3.4 vs 25.7±3.8)kg/m^(2) than that in the open group,and the difference was statistically significant(t was 5.53,5.67 respectively,P<0.01).There was no significant difference in hospitalization days between the two groups(P>0.05).The logarithmic curve of the operation time showed a smooth downward trend,and the overall operation time of the endoscopic group was relatively consistent.There was no significant difference in intraoperative blood loss between the endoscopic group(13.3±3.2) mL and the open group(14.7±6.3) mL(P<0.05),but the operation time(130.1±37.9) min was longer than that in the open group(57.4±13.7) min,and the difference was statistically significant(t=19.40,P<0.01).There was no significant difference in complications such as temporary recurrent laryngeal nerve injury within 3 days after operation between the two groups(P>0.05).The aesthetic satisfaction score of the surgical incision and the incision concealment effect score in the endoscopic group were higher than those in the open group,and the difference was statistically significant(P<0.05).Conclusion:Compared with traditional open thyroidectomy,transaxillary non-inflatable endoscopic thyroidectomy has more advantages in the concealment and aesthetics of postoperative incision.Although the former has longer operation time and more drainage,it is still a safe and feasible surgical method with good postoperative clinical effect.